Predicting Which Teens Are at Risk for Starting to Smoke: A Tool that Can Help
LewisFirst, MD, MS, Editor in Chief, Pediatrics
Wouldn’t it be terrific to be able to see one of your adolescent patients for a health
maintenance visit who has yet to smoke and be able to tell that teen that they are
at risk to start and intervene accordingly? The first step is having a tool that can
make such a prediction with accuracy—and believe it or not, such a tool has been tested
and is being shared in an early release study this week. Sylvestre et al. (10.1542/peds.2017-3701) used data from the “Nicotine Dependence in Teens” study obtained on 1294 students
age 12-13 years from ten high schools in Montreal. These students were sent self-report
questionnaires every three months for 5 school years until completion of high school.
The study authors compiled 58 predictor variables focused on socio-demographics, smoking
habits of family and friends, lifestyle, personality traits and mental health. The
questionnaires also asked about onset of cigarette smoking using 3-month recall questions.
The study authors were able to identify 12 variables that performed exceedingly well
in predicting who would start smoking and combine these into an easy to use tool ideal
for use in the office. You’ll have to link to the article to learn just what these
12 variables are but suffice it to say, they do involve age, 4 stress-related items,
1 depression-related item, 2 self-esteem items, and 4 items that deal with alcohol
So is this tool as good as it sounds? Not necessarily, according to an accompanying
commentary by tobacco prevention specialist Dr. Jonathan Klein from the University
of Illinois at Chicago (10.1542/peds.2018-2298). While recognizing the importance of this study, Dr. Klein also points out some
concerns, such as the tool being constructed before electronic cigarettes were common.
However, Dr Klein also discusses how incorporation of the variables in the tool into
the electronic medical record will allow even easier identification of risk, with
automatically generated alerts to prompt tobacco risk reduction. Hopefully this study
and commentary will light up as a priority read if you care for adolescents in your
practice. If you do use the tool, let us know if you find it as beneficial as the
authors think it will be by sharing your thoughts with a response to this blog, the
article itself as a comment on our website, or via our Facebook and Twitter pages.