Lyndon Haviland

Physician and Dentist Tobacco Use Counseling and Adolescent Smoking Behavior: Results From the 2000 National Youth Tobacco Survey

Objective. The present study describes patterns of tobacco use counseling among physicians and dentists as reported by adolescents and determines the association between provider advice to quit and cessation activities among current smokers. Methods. Data were analyzed from the 2000 National Youth Tobacco Survey, an anonymous, self-administered, school-based survey. The National Youth Tobacco Survey was administered to a nationally representative sample of 35828 students in grades 6 to 12 in 324 schools. Results. Thirty-three percent of adolescents who visited a physician or a dentist in the past year reported that a physician counseled them about the dangers of tobacco use, and 20% reported that a dentist provided a similar message. Among students who smoked in the past year, 16.4% received advice to quit from a physician and 11.6% received advice to quit from a dentist. Physician or dentist advice to quit was correlated with 1 or more quit attempts in the past 12 months. Conclusion. On the basis of adolescent reports, physician and dentist practice patterns remain well below recommended guidelines. Results suggest that provider advice to quit is associated with cessation activity. Additional studies are needed to confirm whether the low prevalence of brief provider tobacco use counseling is a missed opportunity to affect adolescent smoking behavior.

Giving infants a great start: launching a national smoking cessation program for pregnant women.

Data suggest that 12%-22% of women smoke during pregnancy. The link between smoking during pregnancy and adverse health and reproductive outcomes has been well documented. Great Start is a public education and smoking cessation program developed especially for pregnant women. Launched in December 2001, Great Start was the first national program focused on providing free and confidential smoking cessation counseling to pregnant women through a toll-free quitline. Great Start consisted of a media campaign to raise awareness and direct women to telephone counseling tailored for the pregnant smoker, and educational materials designed to support pregnant women through cessation counseling. The program was evaluated to assess the ability of the television ads to reach pregnant smokers and the effectiveness of a quitline for increasing cessation rates among pregnant women. Great Start demonstrates that it is possible to reach pregnant smokers through television ads that provide information about the consequences of smoking while pregnant, are affirming in tone, and provide direction for women to take action. Initial response to the program indicates that pregnant women want to quit and confirms the need for programs designed specifically to address the needs of this population.

A Silence That Kills

Tobacco-related disease kills 178 000 women each year in the United States,1 yet a search for the public discourse on this fact reveals a profound silence. As a nation, we have failed to mount and support an organized public response to the ongoing public health tragedy of tobacco use. The public health community must find a way to give voice to the thousands of families who will experience the premature loss of a loved one because of tobacco use. In creative new ways, we must engage a broad range of partners, both public and private, and help them raise their voices to demand comprehensive action. Although many of us are activists and many are working to counteract tobacco’s harm, the public remains largely silent, its lack of outrage evident in the daily news, in the public debate on smoking bans, and in the lack of pressure on our government to protect workers, families, and children. There is so little public demand for action. We must find ways to spark a national movement to demand the funding and implementation of comprehensive tobacco control programs. We must overcome apathy and public silence. Tobacco control advocates must learn from the AIDS activists that silence equals a continuing saga of disease, suffering, and death. How can we as public health practitioners change this silence into a public demand for comprehensive tobacco control that includes prevention, cessation, and regulation? How can we join together to give voice to the women and men who die each year in America of tobacco-related diseases? How can we prevent the needless suffering of families across the nation that results from tobacco use?

Courage and dignity.

LINDA COSTIGAN STRUGGLED to quit smoking. She was finally successful—but only after she had been diagnosed with lung cancer. By then she had been smoking for 42 years. Although she could do little to save herself, Linda tried to do what she could to educate others about the hazards of smoking. She allowed the American Legacy Foundation to use her image and her brief but heartfelt letters to her daughter, J. C., her friend, Pat, and her granddaughter, Ally, in its 2002– 2003 national advertising campaign against smoking. She was one of 4 women to allow their personal stories to be used in trying to reach the 46 million Americans who are still smoking.1 This haunting photograph was taken by Richard Avedon in March 2002. Linda felt that this advertising campaign gave her life meaning in her final months. This ad and her “voice” is her legacy to the world. Linda Costigan died in January 2003. In remembering Linda Costigan, we should also remember that, each year, 178 000 women die of tobacco-related illnesses.2 Tobacco use is the largest preventable cause of death among women in the United States, responsible for the premature deaths of approximately 3 million women since 1985.3 Linda’s daughter, like many other American women, has herself struggled to quit smoking.