—Dr Perry raises an important point in regard to the role of pediatricians in both primary and secondary prevention. The AHCPR Smoking Cessation Guideline Panel considered at some length inclusion of a primary prevention section, but felt it was of sufficient scope to merit its own guideline. As Perry's description of his smoking cessation program for adults indicates, pediatricians have a unique role to play in smoking cessation, given the connection between a child's health and the smoking behavior of adult caretakers.
Dr Merrick argues strongly that the magnitude of nicotine addiction requires intensive, long-term treatment for a successful outcome. Some patients do benefit from more intense and sustained treatment; indeed, the meta-analyses that provided the scientific support for the AHCPR Smoking Cessation Clinical Practice Guideline found a strong, positive doseresponse relationship between both intensity and duration of treatment and successful cessation. As a result, this finding was the basis