Ask, advise, assist: pediatricians and passive smoke exposure

The objectives of this study were to determine: (1) how frequently pediatricians obtain a history of passive smoke exposure (PSE), (2) what type of advice regarding PSE they offer and how frequently they offer it, and (3) what methods and what assistance they believe would be useful to reduce PSE. A random sample of 1,000 US members (GEN) of the American Academy of Pediatrics (AAP) and all 724 members of the AAP sections of pulmonology, otolaryngology, and allergy (SPECS) were sent a questionnaire. Seven hundred fifty-five usable questionnaires were returned. Ninety-six percent of 321 general pediatricians obtained a PSE history at least "sometimes" but were much more likely to "always" do so when seeing a patient with asthma (87%) or recurrent otitis media (56%) than during well-child visits (41%) (p < 0.0001). Ninety-eight percent of pulmonologists and 95% of allergists "always" obtained a PSE history from parents of their asthmatic patients as compared with generalists who reported doing so 87% of the time (p = 0.0004). Fifteen percent of GEN gave specific assistance to parents with smoking cessation such as referral to an internist or family practitioner or a community agency or initiating a smoking cessation program themselves, whereas 85% gave only nonspecific advice such as, "don't smoke around the child," or "quit smoking." Reasons for not initiating a cessation program included lack of skills (38%) or time (36%) or a belief that it was "not their responsibility" (13%). Pediatricians indicated that brochures for parents that describe the hazards of PSE and contain specific information regarding how to refer to community smoking cessation programs would be of most use to them in helping parents reduce PSE to their children. Pediatricians frequently ask about PSE and advise reducing it but seldom assist parents with specific advice regarding effective methods to quit smoking.