title: Effect of a pediatric practice-based smoking prevention and cessation intervention for adolescents: a randomized, controlled trial.
abstract: OBJECTIVE
  The purpose of this work was to determine whether a pediatric practice-based smoking prevention and cessation intervention increases abstinence rates among adolescents.
  
  
  METHODS
  Eight pediatric primary care clinics were randomly assigned to either intervention or usual care control condition. The provider- and peer-delivered intervention tested was based on the 5A model recommended by the US Public Health Service clinical practice guidelines and the American Academy of Pediatrics and consisted of brief counseling by the pediatric provider followed by 1 visit and 4 telephone calls by older peer counselors aged 21 to 25 years. A consecutive sample of patients aged 13 to 17 years scheduled for an office visit was eligible regardless of smoking status. Of 2711 patients who agreed to participate, 2709 completed baseline assessments, and 2700 (99.6%) and 2690 (99.2%) completed 6- and 12-month assessments, respectively.
  
  
  RESULTS
  Compared with the usual care condition, nonsmokers who received the provider- and peer-delivered intervention were significantly more likely to self-report having remained abstinent at 6-month and 12-month follow-up; smokers who received the provider- and peer-delivered intervention were more likely to report having quit at the 6-month but not the 12-month follow-up. A number of adolescent characteristics (eg, age, peer smoking, tobacco dependence, and susceptibility) were found to be predictive of abstinence at follow-up.
  
  
  CONCLUSIONS
  A pediatric practice-based intervention delivered by pediatric providers and older peer counselors proved feasible and effective in discouraging the initiation of smoking among nonsmoking adolescents for 1 year and in increasing abstinence rates among smokers for 6 months.
authors.affiliation: Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655, USA. lori.pbert@umassmed.edu
authors.forename: Lori
authors.initials: L
authors.lastname: Pbert
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Flint
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Fletcher
authors.forename: Martin H
authors.initials: MH
authors.lastname: Young
authors.forename: Susan
authors.initials: S
authors.lastname: Druker
authors.forename: Joseph R
authors.initials: JR
authors.lastname: DiFranza
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003376:Counseling; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010372:Pediatrics / Q000379:methods; D011216:Practice Management, Medical; D011237:Predictive Value of Tests; D011322:Primary Prevention / Q000379:methods; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D016540:Smoking Cessation / Q000379:methods* / Q000706:statistics & numerical data; D000074606:Smoking Prevention; D018709:Statistics, Nonparametric; D016896:Treatment Outcome