Pediatrician delivery of a teen tobacco cessation intervention

Background: Pediatricians are a trusted source of health information for teens, and should be trained to deliver tobacco cessation interventions during clinical visits. The PHS 5As (Ask-Advise-Assess-Assist-Arrange) intervention has shown success with adult smokers; PHS has called for research on its use with teens.

Method: 142 pediatric practices in the American Academy of Pediatrics (AAP) Pediatric Research in Office Settings (PROS) practice based research network participated in a study of a teen-focused adaptation of the 5As. Teens completed a baseline survey during an office visit and a phone interview 4-6 weeks later. Chi-square analyses assessed teen-reported receipt of tobacco screening and counseling from 5As-trained pediatricians, compared to pediatricians trained in a media use intervention. Multivariable regressions examined predictors of teen receipt of tobacco screening/counseling.

Results: In data from 1175 teens (both smokers and non-smokers), 5As-trained (vs. comparison condition) pediatricians were more likely to Ask about smoking (72% v 52%) and Advise against smoking (71% v 55%). In data from 533 teen smokers, 5As-trained pediatricians were more likely to Assess quit-readiness (62% v 34%) and Assist with quitting (57% v 26%) (all ᵪ² p<0.001). Multivariable logistic regressions showed that teens with a 5As-trained pediatrician were twice as likely to be screened for tobacco (OR=2.33, 95% CI=1.79-3.03) and teen smokers were more than three times as likely to be counseled about smoking (OR=3.11, 95% CI-2.04-4.76).

Conclusion: Our intervention improves delivery of tobacco cessation interventions by pediatricians. Pediatric training may help reinforce public health and other tobacco control interventions in promoting tobacco cessation in communities.