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BMJ. 1991 Oct 19;303(6808):947-50.

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

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MRC Epidemiology and Medical Care Unit, Northwick Park Hospital, Harrow, Middlesex.

Erratum in

  • BMJ 1991 Nov 9;303(6811):1176.



To compare physical, lifestyle, and health characteristics of adolescent smokers and non-smokers and their initial response to anti-smoking counselling.


Adolescents aged 13, 15, and 17 years were identified from age-sex registers and invited by letter for a general practice health check.


Three general practices in the MRC general practice research framework.


Blood pressure, body mass index, saliva cotinine concentration, peak flow rate, alcohol consumption, exercise, duration of sleep, and stated persistent health problems.


73% of the adolescents (491) attended for the health check. A total of 68 (14%) were regular smokers. By age 17 those who smoked regularly had a significantly lower systolic blood pressure than those who had never smoked regularly (by 6 mm Hg; p = 0.025) despite a significantly higher body mass index (by 1.5; p <0.001) [corrected]. 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 greater than or equal to 8 g alcohol a day (chi 2 = 15.2 adjusted for age and sex p less than 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 less than 0.001) and slept less (8.0 hrs/night v 8.5 hrs/night at age 17; p less than 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.


General practice is an appropriate setting for adolescents to receive advice on healthy lifestyle, which should not focus solely on smoking.

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