A 14-year-old girl is brought to the office for an annual wellness examination. The patient has no medical problems. She is accompanied by her distraught mother, who expresses dismay that the patient started smoking 9 months ago. The mother says, "At first she was just experimenting, like kids do. I had hoped it was a phase that would pass, but it has gotten worse. She comes home smelling of smoke almost every day, and has a close friend who also smokes." The daughter now regularly takes cigarettes from her mother's purse to smoke with this friend at school. When seen alone by the pediatrician, the girl reports that she smokes about half a pack of cigarettes a day and buys them from other kids or takes them from her mother's purse. The patient says she knows smoking is bad for her but that, "It's not a big deal; Mom is just overreacting. I am not doing heavy drugs or anything. The other kids get drunk at parties and use marijuana and stuff, which I don't do. I'll have 1 beer at most. Mom just needs to calm down about it." On returning to the room, the mother asks what she can do to help her daughter stop smoking. Which of the following is the most appropriate response by the physician?

Question

A 14-year-old girl is brought to the office for an annual wellness examination.  The patient has no medical problems.  She is accompanied by her distraught mother, who expresses dismay that the patient started smoking 9 months ago.  The mother says, "At first she was just experimenting, like kids do.  I had hoped it was a phase that would pass, but it has gotten worse.  She comes home smelling of smoke almost every day, and has a close friend who also smokes."  The daughter now regularly takes cigarettes from her mother's purse to smoke with this friend at school.  When seen alone by the pediatrician, the girl reports that she smokes about half a pack of cigarettes a day and buys them from other kids or takes them from her mother's purse.  The patient says she knows smoking is bad for her but that, "It's not a big deal; Mom is just overreacting.  I am not doing heavy drugs or anything.  The other kids get drunk at parties and use marijuana and stuff, which I don't do.  I'll have 1 beer at most.  Mom just needs to calm down about it."  On returning to the room, the mother asks what she can do to help her daughter stop smoking.  Which of the following is the most appropriate response by the physician?

Quizplus · Accepted Answer

Explanation: Nicotine is a highly addictive drug, and it is extremely difficult for even the highly motivated to stop smoking. This mother's smoking is likely a trigger for her daughter and may send the unintentional message that smoking is acceptable. Studies have shown that parental smoking has a large influence on adolescent smoking and that smoking-cessation efforts by parents can positively impact their children's efforts. This mother is highly motivated to help her daughter. The best approach is to have a nonjudgmental discussion with the mother about how her smoking may be affecting her daughter and offer to help the mother quit. Counseling about smoking cessation and options for nicotine replacement therapy (eg, patch, gum) should be included in the discussion. (Choice B) This patient has acknowledged that smoking is bad for her. Therefore, it will likely be ineffective for the mother to repeatedly remind her about the health risks, especially when she, herself, continues to smoke. (Choice C) Informing the daughter's friend's mother might be helpful, but the mother should first be encouraged to consider what she could change before placing the responsibility on other adults. (Choice D) Although peer relationships in adolescence are highly influential, it is unrealistic for the mother to supervise all of her daughter's activities with her friend, and doing so would likely strain the mother-daughter relationship. (Choice E) Locking up cigarettes may prevent the daughter from using her mother's cigarettes, but cigarettes can likely be acquired from other kids. Continued exposure to the mother's smoking and to the smell of smoke are strong triggers that are best addressed by helping the mother quit. Educational objective: Smoking cessation is difficult if the smoker remains subject to environmental triggers, including having friends and family who continue to smoke. Parents who want their children to stop smoking should be encouraged and given assistance to quit themselves. References: Parental smoking cessation and adolescent smoking. (http://www.ncbi.nlm.nih.gov/pubmed/12177249)

A 14-Year-Old Girl Is Brought to the Office for an Annual