Identification of adolescent tobacco users in a pediatric practice

Context: Though prevention of adolescent tobacco use is a major public health goal, there is little information on the ability of pediatricians to identify adolescents experimenting with tobacco and regular tobacco users. Objectives: To pilot use of a short questionnaire and analysis of urinary cotinine level to identify adolescent smokers in a pediatric practice, and to determine characteristics of tobacco users. Setting: Suburban pediatric practice. Method: Consecutive high school students completed a short questionnaire and urine cotinine assessment. Three groups were defined: smokers (urine cotinine level > 100 ng/mL), experimenters (smoked within the last year; urine continine level ≤100 ng/mL), and nonsmokers. Logistic regression was used to examine characteristics of experimenters. Results: One hundred twenty-four adolescents were enrolled throughout 3 months: 83 nonsmokers (67%), 28 experimenters (23%), and 13 smokers (10%). The questionnaire alone identified 92% of regular smokers. Smoking frequency increased by grade level. Smoking initiation occurred with peers. Compared with nonsmokers, smokers and experimenters were more likely to be older and have a majority of friends who smoked. Smokers were more likely to have a family member who smoked. A majority of smokers and experimenters had tried to quit and understood the adverse health effects of tobacco use. Conclusions: Adolescent smokers and experimenters were identified using a brief questionnaire. This method will allow pediatricians the opportunity to identify at-risk adolescents before they become regular smokers. Further studies at primary care offices are needed to examine identification of adolescents at highest risk and examine methods to initiate smoking cessation before addiction is established.