Pediatricians' use of the 5 A's and nicotine replacement therapy with adolescent smokers

The purpose of this study was to examine pediatricians' use of nicotine replacement therapy (NRT) and the 5 A's counseling method with adolescent smokers. Using a mail survey, 203 randomly selected pediatricians (52% response rate) responded to a valid and reliable 37-item questionnaire regarding: perceptions of prescribing NRT, confidence in using NRT, perceived barriers to prescribing NRT, sources of information regarding NRT, and use of the 5 A's counseling method. Forty-four percent of pediatricians did not feel competent in helping adolescents quit smoking cigarettes. Less than a fifth (17%) were currently prescribing NRT. A plurality (48%) perceived NRT to be safe for adolescent use but a majority (53%) rated themselves as not confident in their ability to use NRT. Those who prescribed NRT used transdermal patches (81%), nicotine gum (53%), or bupropion (44%). Pediatricians based their decisions on using NRT on whether: the adolescent showed an openness to quitting (78%), the adolescent requested NRT (72%), and if the adolescent had a health problem exacerbated by smoking (56%). The low level of perceived competence in helping adolescents quit smoking may be due to how few pediatricians identified medical school as a major source of information on helping adolescents stop smoking. Even though ample evidence suggests that NRT is safe to use with adolescents, less than half of the responding pediatricians perceived it to be safe, possibly indicating a desire for a more definitive conclusion on its safety before adopting the products or a lack of awareness of existing studies on this topic.