Background: 20% of adolescents report smoking in the past month. Evidence for cessation counseling for adolescents remains limited.

Objective: 1) To recruit and train providers in smoking cessation intervention using the Public Health Service 5As (Ask, Advise, Assess, Assist, Arrange) using a distance learning curriculum, and assess adherence to intervention, and 2) to establish whether primary care pediatric practices can recruit adolescents to tobacco intervention trial without enrollment bias.

Design/Methods: We recruited 35 practitioners from the PROS practice-based research network for a double-blind smoking cessation intervention pilot. Practices were randomized to a brief cessation counseling intervention or comparison condition. Both involved a 45-minute self-study clinician training curriculum. Fidelity to protocols was assessed using criterion standards and during teach-back role-playing follow-up calls with clinicians. Practices recruited eligible adolescents at well visits. Full study participants completed baseline survey at the visit and follow-up phone surveys; youth who initially refused were asked to provide anonymous baseline data only to examine whether differential non-recruitment of smokers affected study sample yield.

Results: 23 (66%) of providers completed training and met standards for intervention delivery. Of 703 teens recruited for the full study and 139 teens for the anonymous survey, 6.1% and 7.1%, respectively, were smokers (p=.70). Although not reaching significance, more teens in the intervention group reported their physician discussed smoking (89 vs 72%; p=.08), asked if they smoke (92 vs 77% ; p=.14), and asked if friends smoked (68 vs 47%; p=.09). Smoker in the intervention group were more often asked if they wanted to quit (43% vs 36%; p=.58) and given materials to help them quit (33% vs 14%; p=.53).

Conclusions: This field pilot demonstrates successful physicians training in delivery of smoking cessation counseling through distance learning and recruitment of teens without differential non-enrollment of smokers. While a lack of statistical power precluded significant findings, intervention clinicians delivered more cessation services than their control counterparts. A full scale RCT is methodologically feasible and appears warranted to examine the impact of brief counseling interventions on adolescent cessation.