Identification of adolescent tobacco users in a pediatric practice

Context: Though prevention of adolescent tobacco use is a major public heal th goal, there is little information on the ability of pediatricians to ide ntify adolescents experimenting with tobacco and regular tobacco users. Objectives: To pilot use of a short questionnaire and analysis of urinary c otinine level to identify adolescent smokers in a pediatric practice, and t o determine characteristics of tobacco users. Setting: Suburban pediatric practice. Method: Consecutive high school students completed a short questionnaire an d urine cotinine assessment. Three groups were defined: smokers (urine coti nine level >100 ng/mL), experimenters (smoked within the last year; urine c ontinine level less than or equal to 100 ng/mL), and nonsmokers. Logistic r egression was used to examine characteristics of experimenters. Results: One hundred twenty-four adolescents were enrolled throughout 3 mon ths: 83 nonsmokers (67%), 28 experimenters (23%), and 13 smelters (10%). Th e questionnaire alone identified 92% of regular smokers. Smoking frequency increased by grade level. Smoking initiation occurred with peers. Compared with nonsmokers, smokers and experimenters were more likely to be older and have a majority of friends who smoked. Smokers were more likely to have a family member who smoked. A majority of smokers and experimenters had tried to quit and understood the adverse health effects of tobacco use. Conclusions: Adolescent smokers and experimenters were identified using a b rief questionnaire. This method will allow pediatricians the opportunity to identify at-risk adolescents before they become regular smokers. Further s tudies at primary care offices are needed to examine identification of adol escents at highest risk and examine methods to initiate smoking cessation b efore addiction is established.