Asking Teens About Tobacco Use

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Case Scenario


Amy complains that her performance on the track team is dropping. She wonders "Could I have mono or something?"

Every clinician should ask each adolescent patient about his or her tobacco use status and recommend complete abstinence (Fiore et al. 2008).

If a child smokes, a tobacco cessation program should be initiated. In some instances, particularly first visits, it may be important for the professional to develop a relationship of trust with the youth and to ask him or her to complete the form later in the visit once the young person feels more comfortable.

Adolescent Privacy

Patient-doctor discussions regarding tobacco use and other sensitive topics for youth, such as other drug use, sex education, depression, and mental health, are confidential in most states (Seattle and King County Public Health 2003).

Several major medical organizations have issued policy statements regarding confidentiality for young patients:

  • The American Medical Association lists 9 key points regarding adolescent confidentiality.

    • Confidential care for adolescents is critical.

    • Physicians should recognize emancipated minors.

    • Physicians should encourage parental involvement when it is in the best interest of the patient.

    • When not in the best interest of the patient, parental notification and consent should not be a barrier.

    • Physicians should explain their policy regarding confidentiality and when it can be abrogated.

    • Physicians should offer examination and counseling apart from parents.

    • State and county medical societies should provide information to physicians clarifying services that may be legally provided on a confidential basis.

    • Undergraduate and graduate education programs should inform physicians of issues of minor consent and confidential care.

    • Healthcare providers should list services to maintain confidentiality.

    • Medical societies should evaluate confidentiality laws and eliminate restricting laws.

    • See AMA Policy H-60.965, Confidential Health Services for Adolescents available on the AMA policy website in the Related Resources section.

  • The American Academy of Pediatrics policy statement recommends that the pediatrician "interview the adolescent alone to obtain a meaningful history of drug use and/or associated problems and to assure confidentiality, except when a threat of harm to self or others exists or when reporting is required by law" (AAP 1998).

  • The American College of Obstetricians and Gynecologists recommends that doctors talk to young patients and their parents, both together and separately, about confidentiality (ACOG 1998).

View ReferencesHide References
American Academy of Pediatrics. Tobacco, alcohol, and other drugs: the role of the pediatrician in prevention and management of substance abuse. Pediatrics. 1998; 101(1): 125-128.
American College of Obstetricians and Gynecologists. ACOG educational bulletin number 249. Confidentiality in adolescent health care. Int J Gynaecol Obstet. 1998; 63(3): 295-300.
Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
Seattle and King County Public Health. Making your practice teen friendly . Seattle and King County Public Health Web site. 9/14/2003. Available at: Accessed on: 2010-06-15.