Collins Lauren, Smiley Sabrina L, Moore Rakiya A, Graham Amanda L, Villanti Andrea C
Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street, NW, Fourth Floor, Washington, DC USA.
Evaluation Science and Research at Truth Initiative, Washington, DC USA.
Tob Induc Dis. 2017 Jan 10;15:2. doi: 10.1186/s12971-016-0107-6. eCollection 2017.
Initiating tobacco use in adolescence increases the risk of nicotine dependence and continued smoking. Physician screening for tobacco use increases the odds of physicians intervening with patients who smoke; However, without appropriate follow-through by the physician, screening for tobacco use is not enough to significantly increase cessation rates. Given the critical phase of development adolescence poses in tobacco use and evidence that physician intervention improves adult cessation efforts, we sought to examine physician tobacco use screening and advice to quit among adolescents (12-17 years).
Using data from the 2013 National Survey on Drug Use and Health (NSDUH), we examined the prevalence and correlates of tobacco use screening in adolescent respondents who reported visiting their physician within the past year ( = 12,798). Multivariable logistic regression analyses explored the relationship between tobacco use screening and physician advice to quit in a sub-set of the sample who reported on physician advice to quit ( = 1,868), controlling for sociodemographics, cigarette use, and substance use and screening.
Only 49% of adolescents who visited a physician within the past year reported being screened for tobacco use. Adolescents who were screened by their physician were predominantly female (56.6%), White (60.1%), in late adolescence (83.0%), and covered by private health insurance (63.8%). Screening for tobacco use was highly correlated with physician advice to quit smoking, controlling for sociodemographic characteristics and cigarette use; this relationship was attenuated, but remained significant, after screening for alcohol and marijuana were added to the model. Hispanic adolescents were significantly less likely to receive physician advice to quit in all multivariable models.
Our findings suggest missed opportunities for youth tobacco use prevention and cessation efforts in the clinical setting. Further research is needed to better facilitate an open dialogue on tobacco use between physicians and their adolescent patients.
青少年开始吸烟会增加尼古丁依赖和持续吸烟的风险。医生对吸烟情况进行筛查会增加医生对吸烟患者进行干预的几率；然而，如果医生没有进行适当的后续跟进，仅对吸烟情况进行筛查不足以显著提高戒烟率。鉴于青少年时期在吸烟问题上所处的关键发育阶段，以及医生干预能改善成年人戒烟效果的证据，我们试图研究医生对青少年（12 - 17岁）吸烟情况的筛查及戒烟建议。
利用2013年全国药物使用和健康调查（NSDUH）的数据，我们对过去一年中报告看过医生的青少年受访者（n = 12,798）的吸烟情况筛查患病率及相关因素进行了研究。多变量逻辑回归分析在报告了医生戒烟建议的样本子集（n = 1,868）中，探讨了吸烟情况筛查与医生戒烟建议之间的关系，同时控制社会人口统计学、吸烟情况、物质使用及筛查等因素。
在过去一年看过医生的青少年中，只有49%的人报告接受过吸烟情况筛查。接受医生筛查的青少年主要为女性（56.6%）、白人（60.1%）、处于青春期后期（83.0%）且有私人医疗保险（63.8%）。在控制社会人口统计学特征和吸烟情况后，吸烟情况筛查与医生戒烟建议高度相关；在模型中加入酒精和大麻使用筛查因素后，这种关系虽有所减弱，但仍具有显著性。在所有多变量模型中，西班牙裔青少年接受医生戒烟建议的可能性显著较低。
我们的研究结果表明，在临床环境中存在预防青少年吸烟和戒烟工作的机会错失情况。需要进一步研究以更好地促进医生与其青少年患者之间就吸烟问题展开开放对话。
