from the Julius B. Richmond Center of Excellence
and the AAP Department of Research
New research using data from AAP Periodic Surveys of Fellows shows that most pediatricians advise
both patients and parents who smoke to quit, but
they are less likely to assist with cessation by recommending nicotine replacement or referring to a quit
line (McMillen R, et al. Acad Pediatr. Jan. 16, 2017,
Pediatricians were asked about specific components of tobacco screening and counseling, based
on the U.S. Public Health Service 5 A’s model (Ask,
Advise, Assess, Assist, Arrange) in 2010 and 2004,
and data revealed positive trends over time. Pediatricians were more likely in 2010 than in 2004 to
report that they help adolescents assess reasons for
and against continuing to smoke (56% vs. 48%)
and were more likely to refer patients to a quit line
(17% vs. 13%).
The authors found that most pediatricians in
2010 advised both adolescent patients and parents
to quit smoking (84% and 69%, respectively), and
many work with their patients and parents to as-
sess reasons for and against continuing to smoke
(56% and 40%). Pediatricians were less likely to
assist patients and parents with tobacco cessation
by providing nicotine replacement therapy or other
resources (17% and 15%) or by referring to a quit
line (17% and 15%).
For all screening and counseling activities, pediatricians reported higher percentages for adolescent
patients than for parent smokers (see figure). Pediatricians who participated in tobacco cessation training and those who routinely documented secondhand smoke exposure were more likely to counsel.
The low levels of assisting with cessation indicate
that pediatricians experience barriers to addressing
tobacco with patients and families in practice. These
barriers may include limited time, competing pri-
orities and uncertainty about evidence-based inter-
ventions for tobacco control.
The pediatric visit is an important opportunity to
address tobacco cessation and prevention of secondhand smoke exposure with the whole family. Data
from this study highlight that pediatricians need
assistance in incorporating brief, evidence-based tobacco cessation interventions into the care delivered
to patients and families.
Periodic Survey #61 was conducted from June
to November 2004, and Periodic Survey #78 was
conducted from August 2010 to January 2011. Each
survey was mailed to approximately 1,600 non-re-tired AAP members in the United States, with a
response rate of 54% in 2004 and 55% in 2010.
Analyses were limited to pediatricians who had completed residency training and who provide health
Most pediatricians advise families to quit smoking,
but few assist with cessation
• For more information about addressing tobacco cessation and secondhand smoke prevention in practice or to
join the AAP Section on Tobacco Control, visit the AAP
Richmond Center’s website at www.richmondcenter.
org or contact Julie Gorzkowski, in the AAP Division
of Tobacco Control and Julius B. Richmond Center of
Excellence, at 847-434-7126 or email@example.com.
• For more information on the Periodic Survey of Fellows,
or contact Blake Sisk, in the AAP Division of Health Services Research, at 847-434-7630 or firstname.lastname@example.org.
Pediatrician tobacco counseling activities for patient and parent smokers, 2010
Source: McMillen R, et al. Acad Pediatr . Jan. 16, 2017, http://dx.doi.org/10.1016/j.acap.2017.01.002
Advise to quit
Assess reasons for and against smoking
Talk about quitting techniques
Recommend nicotine replacement
Provide quitting materials
Refer to quit line
0 10 20 30 40 50 60 70 80 90
of pediatricians providing
Adolescent patient Parent