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Physicians Counseling Smokers A Population-Based Survey of Patients' Perceptions of Health Care Provider—Delivered Smoking Cessation Interventions

Michael G. Goldstein, MD; Raymond Niaura, PhD; Cynthia Willey-Lessne, PhD; Judy DePue, EdD, MPH; Cheryl Eaton, MA; William Rakowski, PhD; Catherine Dubé, EdD
Arch Intern Med. 1997;157(12):1313-1319. doi:10.1001/archinte.1997.00440330047005.
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Objective:  To examine associations between sociodemographic and psychological characteristics of smokers and delivery of 5 types of smoking cessation counseling interventions by physicians and office staff.

Methods:  We used a telephone survey of a population-based sample of adult cigarette smokers (N=3037) who saw a physician in the last year. Primary outcomes included patients' report of whether a physician or other health care provider (1) talked about smoking, (2) advised them to quit, (3) offered help to quit, (4) arranged a follow-up contact, and (5) prescribed nicotine gum or other medication.

Results:  Fifty-one percent of smokers were talked to about their smoking; 45.5% were advised to quit; 14.9% were offered help; 3% had a follow-up appointment arranged; and 8.5% were prescribed medication. In multivariate analyses, the most consistent predictors of receipt of almost all counseling behaviors were medical setting (private physician's office only > care in other settings), health status (fair or poor > good, very good, or excellent), more years of education, greater number of cigarettes smoked per day, stage of readiness to quit smoking (preparation > precontemplation), and greater reported benefits of smoking.

Conclusions:  Physicians and other health care providers are not meeting the standards of smoking intervention outlined by the National Cancer Institute and the Agency for Health Care Policy and Research. Health care providers who intervene only with those patients who are ready to quit smoking are missing opportunities to provide effective smoking interventions to the majority of their patients. Interventions are also less likely to be provided to healthier and lighter smokers.Arch Intern Med. 1997;157:1313-1319


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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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