How well does the health history form identify adolescent smokers?

Background. This study examines the accuracy of adolescents' reports of tobacco use on a health history form completed in the dental office and the relationship between these reports and cessation advice provided by dental professionals. Methods. The authors compared reports of smoking status provided by adolescents during phone interviews with the adolescents' reports of smoking on a health history form completed during a dental visit. Adolescents aged between 14 and 17 years who were scheduled for a dental hygiene visit in a large managed care system were eligible for the study: 1,162 completed the phone interview, and the study staff members audited the charts of a stratified random sample (n = 280) of these. Results. The health history form identified only 38.0 percent of those who reported having smoked in the previous 30 days during the phone interview and 57.4 percent of those who reported having smoked daily. Only 8.9 percent of all subjects interviewed reported that a dentist or a dental hygienist had ever talked with them about smoking. An examination of the chart audit sample indicated that advice was reported more often by adolescents who had identified themselves as smokers on the health history form (odds ratio = 2.62, 95 percent confidence interval = 1.35 to 5.10), but the reported rate of receiving advice still was low (25 percent). Conclusions. Adolescents underreport tobacco use on health history forms that ask them to specify whether they use tobacco products. Dentists and dental staff members provide advice about tobacco use to adolescents only infrequently. Clinical Implications. The wording of tobacco-use screening questions on health history forms and the conditions under which the forms are completed might affect the accuracy of the information adolescents provide.