The clinician's role in preventing smoking initiation.

Initiation of tobacco use begins primarily during childhood and adolescence, and physicians can play a major role in preventing the onset of tobacco use. The National Cancer Institute recommends that physicians incorporate the four A's in their practices--four activities that promote smoking cessation and prevention: ask, advise, assist, and arrange follow-up. Physicians who care for children should include a fifth A, anticipatory guidance. Anticipatory guidance is the practice of providing counsel regarding potential problems. By providing messages that are appropriate to the patient's age and developmental stage, physicians can intervene in early stages of tobacco use. As role models and leaders, physicians can also influence attitudes in the schools and community.