Increasing the efficacy of physician-delivered smoking interventions
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Objective:To assess the relative impacts of three physician-delivered smoking interventions in combination with follow-up contact from behavioral counselors.
Design:Randomized controlled trial with pre-post measures of smoking rates. This paper reports six-month outcome data.
Setting:Participants were recruited from among patients seen by 196 medical and family practice residents in five primary care clinics.
Participants:Participants were 1,286 patients out of 1,946 eligible smokers approached. The patient group was 57% female and 91% white, had an average age of 35 years, and smoked, on average, slightly over one pack per day.
Intervention:Physicians were trained to provide each of three interventions: advice only, brief patient-centered counseling, and counseling plus prescription of nicotine-containing gum (Nicorette™). Half the patients received follow-up in the form of telephone counseling at three-monthly intervals from behavioral counselors.
Measurements and main results:Changes in smoking behaviors were assessed by telephone interview six months after physician intervention. The differences in one-week point prevalence cessation rates among the physician interventions were significant (p<0.01): advice only, 9.1%; counseling, 11.9%; counseling plus gum, 17.4%; with no effect for telephone counseling. The time elapsed from physician encounter to initial quitting and the length of that period of abstinence also showed significant benefit of the counseling interventions. Patients receiving physician counseling were much more likely than those not receiving counseling to rate their physician as very helpful (p<0.001). Multiple regression analyses are also reported.
Conclusion:Smoking intervention counseling provided by physicians is well received by patients and significantly increases the likelihood of cessation at six months, an effect that is augmented by the prescription of nicotine-containing gum, when compared with physician-delivered advice. Follow-up telephone counseling does not contribute significantly to smoking behavior changes.
- Ockene JK. Physician-delivered intervention for smoking cessation: strategies for increasing effectiveness. Prev Med. 1987;16:723–37. CrossRef
- Russell MPH, Wilson C, Taylor W, et al. Effects of general practitioners’ advice against smoking. Br Med J. 1983;287:1782–5.
- Wilson D, Wood G, Johnston N, Sicuvella J. Randomized clinical trial of supportive followup for cigarette smokers in a family practice. Can Med Assoc J. 1982;126:127–9.
- Wilson D, Taylor W, Gilbert R, et al. A randomized trial of a family physician intervention for smoking cessation. JAMA. 1988;260:1570–4. CrossRef
- Cohen SJ, Christen AG, Katz BP, et al. Counseling medical and dental patients about cigarette smoking: the impact of nicotine gum and chart reminders. Am J Public Health. 1987;77:313–6.
- Cohen S, Stookey G, Katz B, Drook C, Smith D. Encouraging primary care physicians to help smokers quit. Ann Intern Med. 1989;110:648–52.
- Cummings SR, Coates TJ, Richard RJ, et al. Training physicians in counseling about smoking cessation: a randomized trial of the “Quit for Life” program. Ann Intern Med. 1989;110:640–7.
- Kottke TE, Brekke ML, Solberg LI, Hughes JR. A randomized trial to increase smoking intervention by physicians: doctors helping smokers, round 1. JAMA. 1989;261:2101–6. CrossRef
- McCracken EC, Stewart MA, Brown JB, McWinney IR. Patient-centered care: the family practice model. Can Fam Phys. 1983;29:2313–6.
- Quirk M, Letendre A. Teching communication skills to first-year medical students. J Med Educ. 1986;61:603–6.
- Jarvis M. Nicotine replacement as sole therapy or as adjunct. In: Pomerleau OF, Pomerleau CS, eds. Nicotine replacemnt. New York: Alan R. Liss, Inc. 1988;145–62.
- Hall SM, Tunstall CD, Ginsberg D, Benowitz NL, Jones RT. Nicotine gum and behavioral treatment: a placebo controlled trial. J Consult Clin Psychol. 1987;55:603–5. CrossRef
- Ockene JK, Quirk ME, Goldberg RJ, et al. A residents’ training program for the development of smoking intervention skills. Arch Intern Med. 1988;148:1039–45. CrossRef
- National Cancer Institute. Quit for good. U.S. Department of Health and Human Services, 1985.
- Fagerstrom KO. Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment. Addict Behav. 1978;3:235–41. CrossRef
- McCullagh P. Regression models for ordinal data. J R Stat Soc (B). 1980;42:109–42.
- Agresti A. Analysis of ordinal categorical data. New York: John Wiley and Sons, Inc., 1984.
- Health and Public Policy Committee, American College of Physicians. Methods for stopping cigarette smoking. Ann Intern Med. 1986;105:281–91.
- Anda RF, Remington PL, Sienko DG, et al. Are physicians advising smokers to quit? The patient’s perspective. JAMA. 1987;257:1916–9. CrossRef
- Ockene JK, Hosmer DW, Williams J, et al. The relationship of patient characteristics to physician delivery of advice to stop smoking. J Gen Intern Med. 1987;2:337–40. CrossRef
- Ockene JK, Aney J, Goldberg RJ, Klar JM, Williams JW. A survey of Massachusetts physicians’ smoking intervention practices. Am J Prev Med. 1988;4:14–20.
- Wechsler H, Levine S, Idelson RK, Rohman M, Taylor JO. The physician’s role in health promotion—a survey of primary care practitioners. N Engl J Med. 1983;308:97–100. CrossRef
- Wells KB, Lewis CE, Leuke B, Schleiter MK, Brook PH. The practices of general and subspecialty internists in counseling about smoking and exercise. Am J Public Health. 1986;76:1009–13.
- Fagerstrom KO. A comparison of psychological and pharmacological treatment in smoking cessation. J Behav Med. 1982;5:343–51. CrossRef
- Prochaska JO, DiClemente CC. Stages and processes of self-change in smoking: toward an integrative model of change. J Consult Clin Psychol. 1983;51:390–595. CrossRef
- Jamrozik K, Fowler G, Vesser M. Placebo controlled trial of nicotine chewing gum in general practice. Br Med J. 1984;289:794–7.
- Petitti DB, Friedman GD, Kahn W. Accuracy of information on smoking habits provided on self-administered research questionnaires. Am J Public Health. 1981;3:308–11.
- Assaf AR, Banspach SW, Carleton RA, McKenney JL. Use of serum cotinine to validate self-reported smoking practices. Proceedings of the annual meeting of the Society of Behavioral Medicine. Boston: April, 1988;106.
- Harris SS, Caspersen CJ, DeFriese GH, Estes EH. Physical activity counseling for healthy adults as a primary preventive intervention in the clinical setting. JAMA. 1989;261:3590–8.
- Report of the National Cholesterol Education Program. Expert Panel on Detection, Evaluation and Treatment of High Cholesterol in Adults. Arch Intern Med. 1988;148:36–69. CrossRef
- Ockene JK. The expanding role of the physician. Am J Public Health. 1987;77:782–3. CrossRef
- Increasing the efficacy of physician-delivered smoking interventions
Journal of General Internal Medicine
Volume 6, Issue 1 , pp 1-8
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- physician counseling
- smoking intervention
- Industry Sectors
- Author Affiliations
- 1. the Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue, North, Worcester, Massachusetts
- 3. the School of Public Health, Division of Public Health, Arnold House, University of Massachusetts, Amherst, Massachusetts
- 4. the Department of Family and Community Medicine, University of Massachusetts Medical School, 55 Lake Avenue, North, Worcester, Massachusetts