{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T04:05:57Z","timestamp":1773288357299,"version":"3.50.1"},"reference-count":62,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2003,2,1]]},"abstract":"<jats:p>Objective. To assess the frequency of clinician-reported delivery of counseling for avoidance of child environmental tobacco smoke (ETS) exposure and tobacco use at periodic well-child visits and at illness visits for asthma and otitis media (OM).<\/jats:p><jats:p>Methods. Combined data from the National Ambulatory Medical Care Survey and the outpatient portion of the National Hospital Ambulatory Medical Care Survey from 1997 to 1999 were analyzed. The frequency of pediatric visits (\u226418 years) that included clinician-reported counseling for tobacco use\/exposure prevention was assessed. Diagnosis-specific visits were determined by using International Classification of Diseases, Ninth Revision codes for asthma (493-), OM (381-, 382-), and well-child visits. Bivariate and regression analyses were performed.<\/jats:p><jats:p>Results. Of 33 823 ambulatory care visits by children, 1.5% were reported to include delivery of tobacco counseling. Only 4.1% of well-child visits, 4.4% of illness visits for asthma, and 0.3% of illness visits for OM included tobacco counseling. With the use of logistic regression models, adolescent patient visits (13\u201318 years) were more likely to include delivery of tobacco counseling than younger child visits [OR = 15.8, 95% CI (7.5\u201333.5)]. Visits by children with Medicaid and those seen by a nurse practitioner or a physician\u2019s assistant were also more likely to include tobacco counseling (odds ratio: 1.6; 95% confidence interval: 1.002\u20132.50; and odds ratio: 3.0; 95% confidence interval: 1.5\u20136.0, respectively). There were no significant differences in counseling delivery by race, ethnicity, or clinician specialty.<\/jats:p><jats:p>Conclusions. Rates of tobacco counseling at well-child visits and at illness visits for diagnoses directly affected by tobacco use and ETS are extremely low. Significant opportunities exist to improve counseling rates for child ETS exposure and adolescent tobacco use in primary care.<\/jats:p>","DOI":"10.1542\/peds.111.2.e162","type":"journal-article","created":{"date-parts":[[2004,8,14]],"date-time":"2004-08-14T00:43:47Z","timestamp":1092444227000},"page":"e162-e167","source":"Crossref","is-referenced-by-count":60,"title":["Tobacco Counseling at Well-Child and Tobacco-Influenced Illness Visits: Opportunities for Improvement"],"prefix":"10.1542","volume":"111","author":[{"given":"Susanne E.","family":"Tanski","sequence":"first","affiliation":[{"name":"Strong Children\u2019s Research Center, University of Rochester, Rochester, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan D.","family":"Klein","sequence":"additional","affiliation":[{"name":"Strong Children\u2019s Research Center, University of Rochester, Rochester, New York"},{"name":"AAP Center for Child Health Research, Rochester, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan P.","family":"Winickoff","sequence":"additional","affiliation":[{"name":"MGH Center for Child and Adolescent Health Policy and Tobacco Research and Treatment Center, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peggy","family":"Auinger","sequence":"additional","affiliation":[{"name":"Strong Children\u2019s Research Center, University of Rochester, Rochester, New York"},{"name":"AAP Center for Child Health Research, Rochester, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Weitzman","sequence":"additional","affiliation":[{"name":"Strong Children\u2019s Research Center, University of Rochester, Rochester, New York"},{"name":"AAP Center for Child Health Research, Rochester, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2003,2,1]]},"reference":[{"key":"2021121010095539900_R1","unstructured":"National Cancer Institute. 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