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Gerbert B, Berg-Smith S, Mancuso M, Caspers N, McPhee S, Null D, Wofsy J. Using Innovative Video Doctor Technology in Primary Care to Deliver Brief Smoking and Alcohol Intervention. Health Promot Pract 2016; 4:249-61. [PMID: 14610995 DOI: 10.1177/1524839903004003009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Given physicians' increased responsibilities and time constraints, it is increasingly difficult for primary care physicians to assume a major role in delivering smoking and alcohol assessment and intervention. The authors developed an innovative use of computer technology in the form of a “video doctor” to support physicians with this. In this article, two brief interventions, delivered by an interactive, multimedia video doctor, that reduce primary care patients' smoking and alcohol use are detailed: (a) a patient-centered advice message and (b) a brief motivational intervention. The authors are testing the use of the video doctor to deliver these interventions in a randomized, controlled study, Project Choice. A pilot study testing the feasibility and acceptability of the video doctor suggests it was well received and accepted by patients (n = 52) and potentially provides an innovative, cost-effective, and practical way to support providers' efforts to reduce smoking and alcohol use in primary care populations.
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Affiliation(s)
- Barbara Gerbert
- Center for Health Improvement and Prevention Studies, University of California, San Francisco, USA
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2
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Bender BG. The Challenge of Reducing Smoking in Low-Income Parents. Am J Respir Crit Care Med 2014; 189:1457-8. [DOI: 10.1164/rccm.201405-0893ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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3
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Kanarek N, Kanarek MS. Smoking cessation in clinical trials and public health studies: a research ethical imperative. Ann Epidemiol 2007; 17:983-7. [PMID: 17855118 DOI: 10.1016/j.annepidem.2007.07.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 07/23/2007] [Accepted: 07/26/2007] [Indexed: 11/17/2022]
Affiliation(s)
- Norma Kanarek
- Department of EnvironmentalHealth Sciences, Bloomberg School of Public Health, 615North Wolfe Street, Baltimore, MD 21205, USA.
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O'Loughlin J, Makni H, Tremblay M, Karp I. Gender differences among general practitioners in smoking cessation counseling practices. Prev Med 2007; 45:208-14. [PMID: 17631386 DOI: 10.1016/j.ypmed.2007.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2006] [Revised: 06/06/2007] [Accepted: 06/07/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To describe gender differences in smoking cessation counseling practices among general practitioners (GPs), and to investigate the association between training for cessation counseling and counseling practices according to gender. METHODS Data were collected in two cross-sectional mail surveys conducted in independent random samples of GPs in Montreal, the first in 1998, and the second in 2000. RESULTS Respondents included 653 GPs (71% of 916 eligible). All indicators of smoking cessation counseling practices were more favorable among female GPs. Higher proportions of female GPs had received training (28% vs. 17%, p=0.002), and were aware of mailed print educational materials related to cessation counseling (81% vs. 57%, p<0.0001). Training among male GPs was associated with higher scores for ascertainment of smoking status (odds ratio (OR) (95% confidence interval)=1.69 (0.97, 2.96)), provision of advice (OR=2.20 (1.23, 3.95)), and provision of adjunct support (OR=2.86 (1.58, 5.16)). Training was not associated with counseling practices among female GPs. CONCLUSIONS Female GPs may not benefit from formal cessation counseling training to the same extent as male GPs, possibly because they read and integrate the content of (easily available) print educational materials into their clinical practice to a greater extent than male GPs. The gender-specific impact of print educational material and formal training on cessation counseling should be evaluated among GPs.
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Affiliation(s)
- Jennifer O'Loughlin
- CR-CHUM and Department of Social and Preventive Medicine, University of Montreal, Montréal, Québec, Canada.
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5
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Haddock CK, Pyle S, Hymowitz N, Schwab J, Burd K. Which pediatric residents assist and arrange follow-up for patients and parents who use tobacco? J Adolesc Health 2005; 36:531-3. [PMID: 15901519 DOI: 10.1016/j.jadohealth.2004.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2003] [Accepted: 02/20/2004] [Indexed: 11/30/2022]
Abstract
The current study seeks to identify predictors of pediatric resident tobacco intervention behaviors. Training in the residency program, beliefs about the appropriateness of pediatric interventions, and beliefs about the availability of effective interventions were most likely to predict intervention with assisting and arranging strategies.
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Affiliation(s)
- C Keith Haddock
- University of Missouri-Kansas City, Mid America Heart Institute, Saint Luke's Hospital, Kansas City, Missouri 64110, USA.
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6
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Packer MM, Kaur JS, Hodge FS, Nan B, Trapp MA, Roubidoux MA. A survey of attendees at Native American health care conferences: knowledge, attitudes, and practices about cigarette smoking. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2005; 20:89-95. [PMID: 16083372 DOI: 10.1207/s15430154jce2002_9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Cigarette smoking rates and related health consequences among Native Americans are the highest of any US ethnic group. METHODS A sample of the attendees at American Indian and Alaska Native health care conferences participated in a survey about cigarette smoking. RESULTS Of 162 respondents, 11.1% were current smokers, 7.5% of physicians were current smokers, and 80% were lifelong nonsmokers. The majority would ask a smoker to put out cigarettes and would not display ashtrays at home. Nearly all Native American physicians asked their patients about smoking and advised smokers to quit. Respondents were more likely to agree that smoking causes lung cancer (98.7%) as compared to knowing of the associations of smoking with cervical cancer (70.2%), depression (54.5%), and that it is more serious in women (55.2%; P < .01). CONCLUSIONS Current smoking rates were low, and the physicians advised smokers to quit. However, there was less awareness about women's health problems that relate to cigarette smoking as compared to other health consequences of smoking.
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Affiliation(s)
- Marie M Packer
- Department of Biology, Eastern Michigan University, Ypsilanti, USA
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7
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Gorin SS, Heck JE. Meta-Analysis of the Efficacy of Tobacco Counseling by Health Care Providers. Cancer Epidemiol Biomarkers Prev 2004. [DOI: 10.1158/1055-9965.2012.13.12] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Given the proportion of American adults who smoke, even if health professionals only have a small effect on quit rates, the public health impact of this change could potentially be enormous. Yet, health care providers may differ in their cessation efficacy. The purpose of this study was to evaluate recent rigorous trials of smoking cessation counseling among physicians, nurses, dentists, and teams of providers: (1) to compare providers on the efficacy of cessation and (2)to determine which intervention and study characteristics explain variations in intervention effects. Thirty-seven randomized clinical trials or quasi-experiments (with control groups) of health care provider–delivered smoking cessation interventions, out of over 200 articles that were published between 1990 and 2004 were collected through searches of Medline, CINAHL, PSYCINFO, and dissertation abstracts, as well as hand searches. The outcome modeled was the mean difference between intervention and control groups in the cessation rates using Hedges g. The univariate results revealed that receiving advice from any health care professional produced increases in quit rates. Multivariate analyses of intervention effects on cessation revealed that physicians were most effective, followed by multiprovider teams, dentists, and nurses. The findings suggest that contact with a health care professional will increase cessation; however, additional training in tobacco control for nurses is warranted. Longer-term studies of smoking cessation, particularly among dentists, are necessary.
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Affiliation(s)
- Sherri Sheinfeld Gorin
- 1Department of Health and Behavior Studies,
- 2Herbert Irving Comprehensive Cancer Center, and
| | - Julia E. Heck
- 3Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Braun BL, Fowles JB, Solberg LI, Kind EA, Lando H, Pine D. Smoking-related attitudes and clinical practices of medical personnel in Minnesota. Am J Prev Med 2004; 27:316-22. [PMID: 15488362 DOI: 10.1016/j.amepre.2004.07.010] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
CONTEXT Effective clinic-based, smoking-cessation activities are not widely implemented. OBJECTIVE To compare and contrast the smoking-cessation attitudes and clinical practices of five types of primary healthcare team members. DESIGN AND SETTING From July to October 2002, a cross-sectional survey was mailed to randomly selected primary care physicians (MDs), advanced practice nurses (APRNs), registered nurses (RNs), licensed practical nurses (LPNs), and medical assistants (MAs). MAIN OUTCOME MEASURES Factors associated with limited smoking-cessation service delivery. RESULTS The overall response rate was 68% (n =3021). Most respondents reported that patients' smoking status was consistently documented at their clinic (79%); other system prompts were less common (30%). Many respondents reported documenting smoking status or recommending quitting; few reported consistently assessing, assisting, or arranging follow-up. The mean rank of smoking cessation as an important preventive service among nine preventive services declined from MDs (1.9) to APRNs (2.5), RNs (3.4), LPNs (4.2), and MAs (4.6). Smoking prevalence increased from 1% in MDs to 3% APRNs, 9% RNs, 17% LPNs, and 22% MAs. Those who reported no consistent smoking-cessation service delivery were more likely to be RNs, LPNs, or MAs, currently smoke, and work more hours. They were less likely to consider patients receptive to cessation messages, to consider themselves qualified to counsel on smoking, or to work in clinics that had smoking-cessation guidelines or system prompts such as chart reminders. CONCLUSIONS Smoking-cessation service delivery may be enhanced if educational offerings, system changes, and training include all clinical staff members.
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Affiliation(s)
- Barbara L Braun
- Health Research Center, Park Nicollet Institute, Minneapolis, Minnesota 55416, USA.
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Norris JW, Namboodiri S, Haque S, Murphy DJ, Sonneberg F. Electronic medical record tobacco use vital sign. Tob Induc Dis 2004; 2:109-15. [PMID: 19570276 PMCID: PMC2671534 DOI: 10.1186/1617-9625-2-2-109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective Determination of the prevalence of tobacco use and impact of tobacco prevention/treatment efforts in an electronic medical record enabled practice utilizing a defined tobacco vital sign variable. Design and Measurements Retrospective cohort study utilizing patient data recorded in an electronic medical record database between July 15, 2001, and May 31, 2003. Patient-reported tobacco use status was obtained for each of 6,771 patients during the pre-provider period of their 24,824 visits during the study period with the recorder blinded to past tobacco use status entries. Results An overall current tobacco use prevalence of 27.1% was found during the study period. Tobacco use status was recorded in 96% of visits. Comparison of initial to final visit tobacco use status demonstrates a consistency rate of 75.0% declaring no change in tobacco status in the 4,522 patients with two or more visits. An 8.6% net tobacco use decline was seen for the practice (p value < 0.001). Conclusion Self reported tobacco use status as a vital sign embedded within the workflow of an electronic medical record enabled practice was a quantitative tool for determination of tobacco use prevalence and a measuring stick of risk prevention/intervention impact.
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Affiliation(s)
- John W Norris
- Division of Medical Informatics, Department of Medicine, New Jersey Medical School.
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Abstract
Substance abuse remains a complex and pervasive conundrum for society and for clinicians seeking to improve the lives of their pediatric patients. Substance abuse is linked to the human instinct for pleasure at any cost and is fueled by enticing encouragement of the media teaching society to seek drug-induced pleasure without fear of negative consequences. Other complications are the limited education about psychoactive substances provided to youth and the health care profession pledged to serve them. Primary care clinicians must provide their adolescent patients with adequate screening and counseling about substance abuse. Treatment of the substance-abusing patient is often a combination of behavioral interventions (including family therapy), and, in limited situations, addiction-specific medications. Research suggests that female drug addicts have a better outcome in female-only drug treatment programs. In addition, new drugs are being developed that target specific brain mechanisms involved in drug addiction; these drugs will have less toxicity and less abuse potential than illicit drugs such as cocaine. Vaccines are being developed that will block the effects of such drugs as cocaine and PCP. Medications developed for the treatment of depression and epilepsy will be a source of medications for the treatment of drug addiction. The study of endorphins and the neurobiology of stress and substance abuse promise to develop potent anti-addiction chemicals, greatly aiding in the war on drug abuse.
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Affiliation(s)
- Donald E Greydanus
- Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, A 110 East Fee Hall, East Lansing, MI 48824, USA.
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Secker-Walker RH, Gnich W, Platt S, Lancaster T. Community interventions for reducing smoking among adults. Cochrane Database Syst Rev 2002; 2002:CD001745. [PMID: 12137631 PMCID: PMC6464950 DOI: 10.1002/14651858.cd001745] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Since smoking behaviour is determined by social context, the best way to reduce the prevalence of smoking may be to use community-wide programmes which use multiple channels to provide reinforcement, support and norms for not smoking. OBJECTIVES To assess the effectiveness of community interventions for reducing the prevalence of smoking. SEARCH STRATEGY We searched the Cochrane Tobacco Addiction Group specialised register, MEDLINE (1966-August 2001) and EMBASE (1980-August 2001) and reference lists of articles. SELECTION CRITERIA Controlled trials of community interventions for reducing smoking prevalence in adult smokers. The primary outcome was smoking behaviour. DATA COLLECTION AND ANALYSIS Data were extracted by one person and checked by a second. MAIN RESULTS Thirty two studies were included, of which seventeen included only one intervention and one comparison community. Only four studies used random assignment of communities to either the intervention or comparison group. The population size of the communities ranged from a few thousand to over 100,000 people. Change in smoking prevalence was measured using cross-sectional follow-up data in 27 studies. The estimated net decline ranged from -1.0% to 3.0% for men and women combined (10 studies). For women, the decline ranged from -0.2% to + 3.5% per year (n=11), and for men the decline ranged from -0.4% to +1.6% per year (n=12). Cigarette consumption and quit rates were only reported in a small number of studies. The two most rigorous studies showed limited evidence of an effect on prevalence. In the US COMMIT study there was no differential decline in prevalence between intervention and control communities, and there was no significant difference in the quit rates of heavier smokers who were the target intervention group. In the Australian CART study there was a significantly greater quit rate for men but not women. REVIEWER'S CONCLUSIONS The failure of the largest and best conducted studies to detect an effect on prevalence of smoking is disappointing. A community approach will remain an important part of health promotion activities, but designers of future programmes will need to take account of this limited effect in determining the scale of projects and the resources devoted to them.
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Affiliation(s)
- R H Secker-Walker
- Health Promotion Research, University of Vermont, 1 South Prospect Street, Burlington, Vermont 05401-3444, USA.
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O'Loughlin J, Makni H, Tremblay M, Lacroix C, Gervais A, Déry V, Meshefedjian G, Paradis G. Smoking cessation counseling practices of general practitioners in Montreal. Prev Med 2001; 33:627-38. [PMID: 11716660 DOI: 10.1006/pmed.2001.0937] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite the cost-effectiveness of physician smoking cessation counseling, many physicians do not adhere to current clinical practice guidelines. METHODS A cross-sectional mail survey was conducted in a random sample of general practitioners in Montreal to document cessation-counseling practices and identify correlates of these activities. RESULTS Of 440 eligible general practitioners, 337 (77%) completed the questionnaire. Despite favorable beliefs/attitudes about cessation counseling, only 10.5% of general practitioners provided "thorough" counseling. While high proportions of general practitioners ascertained smoking status and encouraged patients to quit, relatively few offered adjunct support (i.e., for patients preparing to quit, 49.8% offered follow-up visits; 42.5% offered educational material; 20% referred patients to community resources). Correlates of counseling completeness included high self-efficacy to provide counseling (odds ratio (OR) = 2.0, 95% confidence interval (1.1-3.6)) and favorable beliefs/attitudes about counseling (OR = 3.6 (2.0-6.4)). Correlates of ascertaining smoking status included female gender (OR = 2.3 (1.5-3.5)), high self-efficacy (OR = 3.5 (2.0-5.9)), and favorable beliefs/attitudes (OR = 2.7 (1.6-4.5)). Correlates of offering adjunct support included female gender (OR = 1.9 (1.1-3.2)), awareness of stages of change (OR = 2.4 (1.3-4.4)), and knowledge of community resources to help patients quit (OR = 2.3 (1.3-3.9)). CONCLUSION Support, training, and intervention programs to overcome lack of awareness and knowledge, unfavorable beliefs/attitudes, and low self-efficacy could increase and enhance cessation counseling practices among general practitioners.
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Affiliation(s)
- J O'Loughlin
- Direction de la santé publique, Régie régionale de la santé et des services sociaux de Montréal-Centre, 1301 Sherbrooke Est, Montréal, Québec.
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Abstract
BACKGROUND Statements from the American Academy of Pediatrics encourage pediatricians to address tobacco. However, most fail to do so and little is known about the preparation to intervene on tobacco they receive during residency training. METHODS The Pediatric Residency Training Director Tobacco Survey was mailed to all pediatric residency training directors in the United States. The survey assessed the nature of training and supervision on tobacco, barriers to training, and factors that influence the inclusion of tobacco in the residency training curriculum. RESULTS Seventy percent of the training directors returned the surveys. Relatively few offered training/supervision on tobacco on a formal basis. Training directors were reluctant to treat parents who smoke, were skeptical about third party payer reimbursement, and did not believe that office-based interventions for treating tobacco use among patients were effective. Key barriers to training were competing priorities, lack of training resources, and lack of faculty with expertise on tobacco. CONCLUSION Residency training is an excellent time to train future pediatricians to intervene on tobacco, but too few pediatric training programs have taken up this charge. Much needs to be done to correct this situation and to prepare future pediatricians to meet the tobacco challenge.
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Affiliation(s)
- N Hymowitz
- Department of Psychiatry, New Jersey Medical School, Newark, NJ 07103, USA.
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Zhu SH, Tedeschi G, Anderson CM, Rosbrook B, Byrd M, Johnson CE, Gutiérrez-Terrell E. Telephone counseling as adjuvant treatment for nicotine replacement therapy in a "real-world" setting. Prev Med 2000; 31:357-63. [PMID: 11006060 DOI: 10.1006/pmed.2000.0720] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Physicians prescribing nicotine replacement therapy (NRT), or health plans covering NRT, often want their patients to receive adjuvant behavioral treatment. However, how to do that in a "real world" is unclear. This paper reports results from a public health program that uses proactive telephone counseling as support for physician advice and provides adjuvant treatment for NRT users. METHODS Participants were NRT users (N = 8,832) who called the California Smokers' Helpline, a statewide cessation service that provides proactive counseling, one session before NRT use and multisessions after the smokers received NRT. After receiving NRT, some participants discontinued the counseling while others continued with follow-up sessions. A subset of the 8,832 participants (n = 664) was interviewed 13 months later for quitting status. RESULTS After receiving NRT, 79% of the participants continued with counseling and received 4.2 sessions on average, while 21% of them received only one session. Overall, 82.8% of all participants made a quit attempt. Nicotine patch users were more likely to make an attempt than nicotine gum users (85.2% vs 66.3%), but the relapse probability was the same for these attempts. Those who received multiple counseling were more likely to make an attempt than those receiving single counseling (84.4% vs 77.1%) and were more likely to stay quit for 1 year (25.6% vs 16.1%). CONCLUSIONS Proactive telephone counseling is a promising adjuvant treatment for NRT users in a "real-world" setting: a convenient referral service for supporting health plans or physicians who advise their patients to quit smoking.
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Affiliation(s)
- S H Zhu
- Cancer Center, University of California at San Diego, La Jolla, California, 92093-0905 USA.
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Secker-Walker RH, Dana GS, Solomon LJ, Flynn BS, Geller BM. The role of health professionals in a community-based program to help women quit smoking. Prev Med 2000; 30:126-37. [PMID: 10656840 DOI: 10.1006/pmed.1999.0607] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Health professionals are credible sources of smoking cessation advice. This study describes changes in health professionals' reported provision of smoking cessation counseling activities for women during a community health education project that took place in two intervention counties (I) and compares these to reports from health professionals in two similar comparison counties (C). METHODS Specific smoking cessation activities reported by physicians (I n = 73, C n = 73), dentists (I n = 51, C n = 46), dental hygienists (I n = 38, C n = 44), family planning and WIC (Special Supplemental Food Program for Women, Infants and Children) counselors (I n = 14 C n = 16), and community mental health counselors (I n = 57, C n = 23) were assessed by mailed surveys at baseline, after 4 years of countywide interventions, and 2 years later. RESULTS Compared with health professionals in the comparison counties, significant increases in smoking cessation training (P < 0.01) and in reported referral of women to stop smoking groups, support groups, and one-to-one support were noted for physicians, family planning, and WIC counselors (P < 0.001); in training and referral to stop smoking groups and support groups by dentists and dental hygienists (P < 0.05); and in referral to support groups by community mental health counselors (P < 0.05). Significant increases in setting quit dates (P < 0.05) and providing self-help materials (P < 0.01) were also noted for family planning and WIC counselors. These effects were no longer demonstrable 2 years after external support for the countywide interventions was withdrawn. CONCLUSIONS We suggest that an important aspect of facilitating consistent smoking cessation advice and counseling from health professionals in the future will be the provision of a broader range of regularly available smoking cessation support systems within communities than is generally available at this time in the United States.
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Affiliation(s)
- R H Secker-Walker
- Office of Health Promotion Research, University of Vermont, Burlington,Vermont, USA.
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Zapka JG, Pbert L, Stoddard AM, Ockene JK, Goins KV, Bonollo D. Smoking cessation counseling with pregnant and postpartum women: a survey of community health center providers. Am J Public Health 2000; 90:78-84. [PMID: 10630141 PMCID: PMC1446113 DOI: 10.2105/ajph.90.1.78] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study assessed providers' performance of smoking cessation counseling steps with low-income pregnant and postpartum women receiving care at community health centers. METHODS WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) program staff, obstetric clinicians, and pediatric clinicians at 6 community health centers were asked to complete surveys. Smoking intervention practices (performance), knowledge and attitudes, and organizational facilitators were measured. Factors associated with performance were explored with analysis of variance and regression analysis. RESULTS Performance scores differed significantly by clinic and provider type. Providers in obstetric clinics had the highest scores and those in pediatric clinics had the lowest scores. Nurse practitioners and nutritionists had higher scores than other providers. Clinic type, greater smoking-related knowledge, older age, and perception of smoking cessation as a priority were independently related to better counseling performance. CONCLUSIONS Mean performance scores demonstrated room for improvement in all groups. Low scores for performance of steps beyond assessment and advice indicate a need for emphasis on the assistance and follow-up steps of national guidelines. Providers' own commitment to helping mothers stop smoking was important.
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Affiliation(s)
- J G Zapka
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester 01655, USA.
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Zapka J, Estabrook B, Gilliland J, Leviton L, Meischke H, Melville S, Taylor J, Daya M, Laing B, Meshack A, Reyna R, Robbins M, Hand M, Finnegan J. Health care providers' perspectives on patient delay for seeking care for symptoms of acute myocardial infarction. HEALTH EDUCATION & BEHAVIOR 1999; 26:714-33. [PMID: 10533175 DOI: 10.1177/109019819902600511] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To inform intervention development in a multisite randomized community trial, the Rapid Early Action for Coronary Treatment (REACT) project formative research was undertaken for the purpose of investigating the knowledge, beliefs, perceptions, and usual practice of health care professionals. A total of 24 key informant interviews of cardiologists and emergency physicians and 15 focus groups (91 participants) were conducted in five major geographic regions: Northeast, Northwest, Southeast, Southwest, and Midwest. Transcript analyses revealed that clinicians are somewhat unaware of the empirical evidence related to the problem of patient delay, are concerned about the practice constraints they face, and would benefit from concrete suggestions about how to improve patient education and encourage fast action. Findings provide guidance for selection of educational strategies and messages for health providers as well as patients and the public.
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Affiliation(s)
- J Zapka
- University of Massachusetts Medical Center, Worcester, MA 01655, USA.
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Zapka JG, Fletcher K, Pbert L, Druker SK, Ockene JK, Chen L. The perceptions and practices of pediatricians: tobacco intervention. Pediatrics 1999; 103:e65. [PMID: 10224209 DOI: 10.1542/peds.103.5.e65] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To investigate pediatrician self-reported intervention practices related to tobacco use and cessation. We queried about practices with three groups 1) children/adolescents who do not smoke; 2) children/adolescents who smoke; and 3) parents, and the relationship of counseling practices with the personal and professional practice-related factors of pediatricians. DESIGN Mailed anonymous survey regarding their self-reported tobacco use prevention and cessation intervention practices. POPULATION Random sample of 350 pediatricians in one state. RESULTS A response rate of 75% was achieved. Pediatricians reported the greatest counseling practice in encouraging children/adolescents to not start smoking, followed by counseling adolescents who smoke. The lowest practice score was for intervening with parents who smoke. The age, gender, site of practice (eg, HMO, solo practice), and subspecialty status of the pediatricians were not related to practice. Pediatricians who reported at least some community involvement in local tobacco control efforts reported significantly higher levels of smoking cessation counseling with both children and adolescents and with parents who smoke. Pediatricians who reported previous training in counseling about tobacco issues also reported significantly higher levels of counseling of both adolescent smokers and parents who smoke but not of children and adolescents who do not smoke. Higher role perception, believing that smoking cessation counseling provided by pediatricians can be effective, and self-efficacy, were predictive of intervention with all three groups. The perceived barriers scale was not related to intervention with any group. CONCLUSIONS Pediatricians are missing opportunities to help their patients to stop smoking and to prevent smoking initiation. Pediatricians are intervening least frequently with parents who smoke. Practices should be tailored to the specific target group.
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Affiliation(s)
- J G Zapka
- Divisions of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA.
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Abstract
BACKGROUND This study describes opportunistic smoking-cessation counseling and compares strategies used in general practice to experts' recommendations. METHODS In this observational study we analysed 157 videotaped consultations with self-reported smokers, visiting 70 Australian general practitioners (GPs) who were randomly enrolled in the Victorian General Practice Study. Smoking-cessation strategies were analysed using a rating form assessed for intrarater reliability and compared to recommendations of 20 experts surveyed to ascertain effective and feasible strategies. RESULTS GPs identified smokers in 32% of consultations and counselled them in 29%. Median counselling time was 44 seconds in encounters typically lasting 10 minutes. When smoking was raised, advice to quit, personalising risks, discussing health risks, and quantifying consumption were the most commonly used strategies (46%-54%). Assessment of motivation to quit, individualised education, practical hints to stop, written materials, and follow-up were observed in a third or less of interventions. Quit dates and nicotine replacement were never proposed. CONCLUSIONS GPs miss many opportunities to advise smokers to quit and rarely use effective smoking-cessation techniques as recommended. Medical education has failed to provide GPs with skills to counsel smokers routinely and effectively. We recommend better training of GPs in effective smoking-cessation strategies and incentives to facilitate their implementation in practice.
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Affiliation(s)
- J P Humair
- School of Medical Education, The University of New South Wales, Sydney, Australia
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Zapka JG, Fletcher KE, Ma Y, Pbert L. Physicians and smoking cessation. Development of survey measures. Eval Health Prof 1997; 20:407-27. [PMID: 10183332 DOI: 10.1177/016327879702000403] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Data from a mailed survey to primary care physicians (N = 122) were used to construct and evaluate psychosocial scales related to performance of smoking cessation counseling. Scales measuring counseling barriers, self-efficacy, and motivation demonstrated considerable promise with excellent or reasonable internal consistency. The correlation for each scale with performance of cessation counseling and with stage of change was statistically significant. Physicians who report they are currently assisting patients had higher performance and self-efficacy rating. Physicians who had participated in formal smoking cessation training had higher self-efficacy; however, their scores on the Barriers, Motivation, and Performance Scales did not differ. Further study with a representative group is encouraged.
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Affiliation(s)
- J G Zapka
- University of Massachusetts Medical Center, Worcester, USA
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