SAN DIEGO, March 3 -- By asking a few simple questions, along with getting a urine sample, physicians can determine which of their pre-teen and teenage patients smoke cigarettes. That's according to a study being presented today at the American Heart Association L. J. Filer Jr. Third International Conference on Atherosclerosis in the Young.
"It's a simple method that fills a major gap," says Samuel S. Gidding, M.D., an author of the study and associate professor of pediatrics and preventive medicine at Northwestern University Medical School, Chicago. "Until now, physicians were expected to find some way to identify the smokers among their teen patients and then counsel them on how to quit smoking. Unfortunately, there has been little information previously on how doctors should go about it," he says. Not only that, but it's a time-consuming task, and one that was falling through the cracks at many physician's offices according to previous research," Gidding says.
"Our study found that kids who smoke can be identified by their physicians, and intervention should occur," says Gidding. "This method also helps doctors identify so-called 'experimenters' - those young people who smoke occasionally, but haven't committed to the habit full time," he says.
Key questions in the written survey are, "Do you smoke?" and "How many cigarettes have you smoked in the past month?" The survey also asks the patients questions about the smoking habits of their friends and family members.
Gidding says the number of cigarettes a young person smokes is a key indicator of just how addicted he or she is. "Reporting less than one cigarette a month makes the young person more likely to be an experimenter, and these individuals are at risk of eventually progressing to heavier tobacco use," he says.
Researchers say a teen whose friends and/or family smoke are more likely than other patients to be smokers themselves. "Parents who smoke are a particularly strong indicator," Gidding says. "When kids smoke, we usually find that their parents are smokers as well. It seems to create a permissive environment for tobacco use."
Gidding and his colleagues used a longer version of the survey containing 26 questions as a study tool at a pediatric clinic to determine if the method for uncovering adolescent smokers was effective. Gidding says it appeared to be a useful tool. "We also found that young people will be honest about their smoking habits, as long as their physician promises confidentiality."
The study looked at 124 patients ages 14 through 18. Most of them (71 percent) were male. Eighty-four (68 percent) of the patients said they were non-smokers. Another 25 patients, or 20 percent, were classified as "experimenters." The remaining 15 patients, or 12 percent, were smokers.
Gidding says analyzing the urine sample to detect cotinine - a byproduct of nicotine that stays in the body for a longer period of time than nicotine - was a valuable backup for the questionnaire. One regular smoker, and two who might be considered experimenters, were identified this way after reporting not smoking or smoking less than one cigarette a month on the survey.
Seventy-three of the adolescents who smoked reported having a family member who smoked, compared to 44 percent of the experimenters and 26 percent of the non-smokers. The smokers and experimenters also had more friends who smoked compared to the non-smokers.
"Though all of the teens rated smoking as harmful on a 5-point scale, the non-smokers perceived smoking to be very harmful, whereas the smokers and experimenters thought it was slightly less harmful," Gidding says.
"The beliefs and experiences were similar among the experimenters and the smokers. This indicates that experimenters could easily become habitual smokers," he says.
Co-authors are I. Benuck, M.D.; and Helen J. Binns, M.D., Ph.D.
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