We agree with the comments made by Dr Bradford. In a cross-sectional study of self-reported behavior, no cause-effect conclusions can be drawn. We acknowledge that there are fundamental differences between the specialties, but the reported behavior by the groups of specialists stands as the data shows.
The prescription of nicotine replacement therapies is not within the usual boundaries of pediatricians. However, nicotine gum and patches are available without a prescription to any adult. Also, pediatricians are able to recommend smoking cessation and spend 3 minutes of counseling on effective techniques, including suggestions to use over-the-counter nicotine replacement products and to attend a smoking cessation program. To implement cessation counseling, the pediatrician must record parental smoking and tobacco exposure on the pediatric health problem list in the patient's medical record because young children usually cannot avoid the environment in which a parent or other adult is smoking. Furthermore, because parents often have more contact with their child's pediatrician than with their own physician, pediatricians could schedule routine follow-ups to discuss parental smoking and secondhand smoke. Pediatricians and family physicians would benefit from additional training to implement these simple interventions in routine office visits since neither group of physicians had a very high rate of reporting these practices. We considered the possibility that the parents who received smoking counseling could have been patients of the family physicians. However, our data indicate that family physicians refer parents to the parents' personal physicians at a similar rate as do pediatricians (37% vs 36%, respectively) and therefore, in 37% of visits, family physicians are not the primary physicians for parents of their pediatric patients.