Doctors are failing to identify smoking status in about half of the adolescent patients seen, according to a University of Wisconsin-Madison study. Physicians addressed tobacco use even less with younger teens, missing an opportunity to intervene with those experimenting with tobacco use.
Based on an audit of Wisconsin Medicaid medical records, researchers found those least likely to be asked about their smoking status were younger patients, patients who were not pregnant and those from rural areas. Just 55 percent of adolescent patients seeing a physician in a two-year period were asked about their smoking status and only five percent of patients' charts included smoking status as a vital sign, a government-backed recommendation.
"Previous studies may have overestimated interventions with adolescents because they were based on physician self report," says Tammy Sims, M.D., M.S., the study's lead author from University of Wisconsin Transdisciplinary Tobacco Use Research Center. "Through analysis of patient charts, we have found that physicians are losing a golden opportunity to intervene with current teen smokers and to dissuade potential smokers among the younger teen population."
Information for the study, published in the journal Health Services Research was gleaned from patient charts randomly selected from Wisconsin Medicaid HMO eligibility files from January 1997 to January 1999. The study, focused on individuals 11 to 21 years old, found that tobacco use was documented on 55 percent of patient charts. Of those documented, 35 percent were current tobacco users (99.3 smokers and 0.7 percent smokeless tobacco users), 8 percent were former smokers and 57 percent had never smoked.
This analysis focused on the high-risk, low-income population enrolled in the Medicaid program. Previous research has indicated that individuals with less education and lower incomes are more likely to start smoking and less likely to quit.
"We chose Medicaid recipients because, given the disproportionate burden of illness caused by tobacco use found in lower income groups, we believed it was important to know what interventions they were receiving," says Sims.
The study found that older adolescents were more likely to have their smoking status recorded than younger adolescents. In fact, the odds of having smoking status documented in their charts increased by 21 percent for every one-year increase in the patient's age. Smoking status was less likely to be recorded in charts of patients from rural areas. Patients in urban or suburban areas were almost twice as likely as rural patients to have smoking status recorded.
"We also saw a failure to address tobacco status at more than one visit," Sims says. "This coupled with their reluctance to ask younger adolescents about smoking status means that physicians were unlikely to identify early experimenters--another missed opportunity."