Doctors should be discussing smoking risks with teens, federal panel recommends

A government task force recommended on Monday that doctors discuss the dangers of smoking with all patients ages 10 to 17, citing evidence that children who learn about the dangers of smoking from their doctors will be less likely to become addicted to cigarettes. What may be most surprising to both parents and physicians is that such recommendations weren’t already in place.

“There was some uncertainly as to whether physicians could prevent smoking in children” back when the last recommendations were issued nearly a decade ago, said Dr. David Grossman, a senior investigator at Group Health Research Institute in Seattle who served on the US Preventive Services Task Force, which issued the draft guidelines. The panel reviewed 19 recent studies, which found that anti-smoking efforts helped regardless of whether a doctor had a face-to-face discussion with teens, handed them an educational pamphlet about smoking risks, or mailed materials to patients’ homes.

Implementing such prevention practices could help curtail the high smoking rates among American children, according to Grossman. More than 8 percent of middle school students and 24 percent of high school students have reported using some kind of tobacco product, according to 2009 statistics, the latest available, from the federal Centers for Disease Control and Prevention.

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The expert panel didn’t find that any one prevention technique worked better than the rest, and it wrote that educating kids as young as 10 about cigarette hazards didn’t have any downsides, such as encouraging some kids to take up the habit out of rebelliousness.

“I do think kids care about what their doctor says if they’re spoken to in a respectful way,” said Dr. Claire McCarthy, a pediatrician at Boston Children’s Hospital. She said she routinely discusses smoking dangers with her patients, starting at age 10 or 11, often out of earshot of their parents. The bad taste, smell, and addictive nature of cigarettes, she added, really resonates with kids, and few in her practice have admitted that they smoke.

McCarthy also lectures parents on their own smoking habits. “I tell them you can’t expect your kids to avoid cigarettes if you’re lighting up yourself.”

In 2009, the American Academy of Pediatrics recommended that pediatricians counsel patients as young as age 5 years old against tobacco use and to provide cessation counseling to kids who were smoking or using chewing tobacco. The medical group also recommended that pediatricians advise all families to make their homes and cars smokefree, and even recommended that doctors avoid smoking to set a good example.

When it comes to pediatricians discussing alcohol and illegal drug use with kids, the Preventive Services Task Force states that there isn’t enough evidence to make a recommendation one way or the other. Those guidelines haven’t been updated in at least three years, so the advice could change after the experts review the latest studies.

McCarthy said she also discusses alcohol and marijuana use with her teen patients but the conversations have to be more nuanced. “They perceive beer and pot to be less risky and less of a problem because they’re not as hard to stop as cigarettes,” she said.

A provocative new study from Boston Children’s Hospital suggests that teens who overeat regularly or binge uncontrollably on certain foods were more than twice as likely to use marijuana and were slightly more likely to use other illegal drugs compared with those who didn’t overeat or binge. While the study, which reviewed medical and dietary surveys from nearly 17,000 tweens and teens, didn’t prove that abnormal eating habits led to more frequent drug use, it’s another clue doctors can rely on to help guide them when they see teens during yearly physicals.

“Physicians should be aware that overeating and binge eating puts teens at risk for other problems and should be sure to screen for these behaviors so they can be addressed early,” said Kendrin Sonneville, who co-authored the study published in the journal Archives of Pediatric and Adolescent Medicine.

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