Adolescent smoking: epidemiology and approaches for achieving cessation.

The initiation of smoking typically occurs during adolescence. To date, most adolescent smoking control efforts have focused on prevention; attempting to identify and influence factors that contribute to experimentation and initiation. However, given the large number of adolescent smokers, it is important that effort also be directed toward facilitating cessation. Many adolescents are addicted to cigarettes and report withdrawal symptoms that are similar to those experienced by adults. Relapse rates are high; few adolescents who try to quit on their own are successful. Clinician-delivered smoking cessation interventions have a positive impact in adults and should be applied to adolescents to promote and sustain abstinence. Although pharmaceutical aids for cessation have been shown to be well tolerated and effective in adults, less is known about their use in adolescents. As such, clinicians are encouraged to explore whether pharmaceutical aids have been approved for use in adolescents in their country and to use discretion when considering their use in patients <18 years of age. Because pediatricians are in a unique position to facilitate tobacco cessation counseling, they should routinely ask their patients whether they use tobacco, advise users to quit, assess readiness to quit, assist with quitting, and arrange follow-up counseling. Tobacco cessation efforts can be enhanced by teaming with other health professionals (e.g. nurses, dentists, pharmacists, social workers) or worksite and community-based organizations that provide health promotion services.

Continuing medical education: what delivery format do physicians prefer?

BACKGROUND: Although physicians are in a unique position to prevent life-threatening outcomes by counseling patients to stop smoking, many of them miss the opportunity to intervene in their patients' use of tobacco. Nicotine Dependence Across the Lifespan was developed as a continuing medical education (CME) program to teach and encourage physicians to deliver effective tobacco prevention and tobacco cessation counseling. METHODS: This CME program was offered to Texas physicians, free of charge, in three formats: live lectures, videotapes, and World Wide Web-based training. The program targeted physicians in four rural areas of Texas (San Angelo, Harlingen, Tyler, and Lubbock), where high smoking rates are prevalent and the number of professional smoking cessation services is low. We examined the sociodemographic characteristics of the participating physicians, factors in their decisions to participate in the program, and the extent to which their reported CME format preferences were associated with age, gender, race, profession, and location. RESULTS: The four factors identified--professional development, cost, personal control, and convenience/complexity--explained 76.9% of the variance describing the reasons physicians participated in the CME offering. The physicians' preferred CME format was live lectures; based on responses, this did not differ across age, gender, race/ethnicity, and location. DISCUSSION: Live lecture continues to be a preferred format of CME for physicians in four rural areas of Texas, yet research continues to show that lecture results in only the lowest level of behavioral change.