a prognostic tool to identify adolescents at high risk of becoming daily smokers预后的工具来识别高危青少年成为每日吸烟者.pdfVIP

Karp et al. BMC Pediatrics 2011, 11:70 /1471-2431/11/70 RESEARCH ARTICLE Open Access A prognostic tool to identify adolescents at high risk of becoming daily smokers Igor Karp1,2*, Gilles Paradis3,4,5, Marie Lambert6,7, Erika Dugas1 and Jennifer O’Loughlin1,2,5 Abstract Background: The American Academy of Pediatrics advocates that pediatricians should be involved in tobacco counseling and has developed guidelines for counseling. We present a prognostic tool for use by health care practitioners in both clinical and non-clinical settings, to identify adolescents at risk of becoming daily smokers. Methods: Data were drawn from the Nicotine Dependence in Teens (NDIT) Study, a prospective investigation of 1293 adolescents, initially aged 12-13 years, recruited in 10 secondary schools in Montreal, Canada in 1999. Questionnaires were administered every three months for five years. The prognostic tool was developed using estimated coefficients from multivariable logistic models. Model overfitting was corrected using bootstrap cross- validation. Goodness-of-fit and predictive ability of the models were assessed by R2, the c-statistic, and the Hosmer- Lemeshow test. Results: The 1-year and 2-year probability of initiating daily smoking was a joint function of seven individual characteristics: age; ever smoked; ever felt like you needed a cigarette; parent(s) smoke; sibling(s) smoke; friend(s) smoke; and ever drank alcohol. The models were characterized by reasonably good fit and predictive ability. They were transformed into user-friendly tables such that the risk of daily smoking can be easily computed by summing points for responses to each item. The prognostic tool is also available on-line at http://episerve.chumontreal.qc.ca/ calculation_risk/daily-risk/daily_smokingadd.php. Conclusions: The prognostic tool to ide