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OBJECTIVES: This study examined the effect of an orthodontist-delivered tobacco-use prevention program for adolescents. METHODS: Southern California orthodontic offices were randomly assigned to experimental (n = 77) and control (n = 77) groups. Randomly selected adolescents were interviewed at baseline and 2 years later (n = 15,644). Experimental offices received tobacco prevention training, anti-tobacco materials, and 50 cents for each anti-tobacco "prescription" written. RESULTS: The 30-day tobacco use 2-year incidence rates for the control and experimental groups were 12.6% and 12.0%, respectively; incidence rates for using tobacco more than 100 times were 7.6% and 6.8%. Differences between the groups did not reach significance. Mean prescription compliance was 64.4%. A multivariate logistic model, showed a significant dose response: patients who received more prescriptions had lower incidence rates than those who received few or none (10% vs 14%). CONCLUSIONS: Training, payment, and support did not ensure clinician compliance with prevention services. The dose effect suggests that replication under conditions that would ensure clinician compliance and statistical power would more thoroughly test clinicians' ability to prevent tobacco use.

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