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The purpose of this study was to examine family and peer influences on smoking behaviors among 239 (191 smokers; 48 nonsmokers) psychiatrically hospitalized adolescents. Participants were queried using scales to measure parental supervision and monitoring, parenting style, adolescent-parent communication, family conflict and relations with parents, and the importance placed on life goals. The results of this study are consistent with previous findings from general population studies. Psychiatrically hospitalized adolescents' smoking status were also correlated with their siblings', peers', and girlfriends'/boyfriends' smoking status. In addition, we found that parental monitoring, closeness to parents, and ambitious life goals were protective factors against smoking. As a result, peer and family influences strongly impact the initiation and maintenance of adolescent smoking and should be considered when designing smoking cessation interventions for adolescents with psychiatric disorders.

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Managed care, an attempt to control the cost of medical care, has had a significant impact on mental health treatment, presumably with financial and therapeutic benefits such as the prevention of excessive or unnecessary treatment. Yet the impact of managed care is not all positive. As a child and adolescent psychiatrist since 1986, participating in thousands of managed care reviews and hundreds of hours in reviews and insurance‐related meetings, I believe that managed care too often interferes with quality mental health care.