Adolescent smokers seen in general practice: Health, lifestyle, physical measurements, and response to antismoking advice

Abstract

Objective - To compare physical, lifestyle, and health characteristics of adolescent smokers and non-smokers and their initial response to anti-smoking counselling. Design - Adolescents aged 13, 15, and 17 years were identified from age-sex registers and invited by letter for a general practice health check. Setting - Three general practices in the MRC general practice research framework. Main outcome measures - Blood pressure, body mass index, saliva cotinine concentration, peak flow rate, alcohol consumption, exercise, duration of sleep, and stated persistent health problems. Results - 73% of the adolescents (491) attended for the health check. A total of 68 (14%) were regular smokers. Those who had never smoked regularly had a significantly lower systolic blood pressure than regular smokers by age 17 (by 6 mm Hg; p = 0.025) despite a significantly higher body mass index (by 1.5; p < 0.001). Cotinine concentrations increased with smoking exposure, from 0.7 ng/ml when no family member smoked to 155 ng/ml in active smokers of six or more cigarettes a week. Significantly more regular smokers than never regular smokers drank ≥8 g alcohol a day (χ2 = 15.2 adjusted for age and sex p < 0.001); regular smokers exercised less (1.0 hrs/week in boys and 0.8 hrs/week in girls v 3.4 hrs/week in boys and 2.2 hrs/week in girls; p < 0.001) and slept less (8.0 hrs/night v 8.5 hrs/night at age 17; p < 0.005). Persistent health problems, mostly asthma or allergic symptoms, were reported by 25% (17/68) of the smokers and 16% (60/381) of the non-smokers. Of the smokers given counselling, 60% (26/43) made an agreement with the practice doctor or nurse to give up smoking. Conclusion - General practice is an appropriate setting for adolescents to receive advice on healthy lifestyle, which should not focus solely on smoking.