Physician tobacco screening and advice to quit among U.S. adolescents - National Survey on Drug Use and Health, 2013

Background: 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). Methods: 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 (N = 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 (n = 1,868), controlling for sociodemographics, cigarette use, and substance use and screening. Results: 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. Conclusions: 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.