Journal of General Internal Medicine

, Volume 22, Issue 4, pp 478–484 | Cite as

Randomized Controlled Trial of a Computer-Based, Tailored Intervention to Increase Smoking Cessation Counseling by Primary Care Physicians

  • Marina UnrodEmail author
  • Meredith Smith
  • Bonnie Spring
  • Judith DePue
  • William Redd
  • Gary Winkel
Original Article


The primary care visit represents an important venue for intervening with a large population of smokers. However, physician adherence to the Smoking Cessation Clinical Guideline (5As) remains low. We evaluated the effectiveness of a computer-tailored intervention designed to increase smoking cessation counseling by primary care physicians.


Physicians and their patients were randomized to either intervention or control conditions. In addition to brief smoking cessation training, intervention physicians and patients received a one-page report that characterized the patients’ smoking habit and history and offered tailored recommendations. Physician performance of the 5As was assessed via patient exit interviews. Quit rates and smoking behaviors were assessed 6 months postintervention via patient phone interviews. Intervention effects were tested in a sample of 70 physicians and 518 of their patients. Results were analyzed via generalized and mixed linear modeling controlling for clustering.

Measurements and Main Results

Intervention physicians exceeded controls on “Assess” (OR 5.06; 95% CI 3.22, 7.95), “Advise” (OR 2.79; 95% CI 1.70, 4.59), “Assist–set goals” (OR 4.31; 95% CI 2.59, 7.16), “Assist–provide written materials” (OR 5.14; 95% CI 2.60, 10.14), “Assist–provide referral” (OR 6.48; 95% CI 3.11, 13.49), “Assist–discuss medication” (OR 4.72;95% CI 2.90, 7.68), and “Arrange” (OR 8.14; 95% CI 3.98, 16.68), all p values being < 0.0001. Intervention patients were 1.77 (CI 0.94, 3.34,p = 0.078) times more likely than controls to be abstinent (12 versus 8%), a difference that approached, but did not reach statistical significance, and surpassed controls on number of days quit (18.4 versus 12.2, p < .05) but not on number of quit attempts.


The use of a brief computer-tailored report improved physicians’ implementation of the 5As and had a modest effect on patients’ smoking behaviors 6 months postintervention.

Key words

smoking cessation computer-tailored intervention primary care 



The authors thank and acknowledge Shannon Erisman and Quinne Leyden for their contributions in data collection.

Potential Financial Conflicts of Interest

None disclosed.


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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Marina Unrod
    • 1
    • 5
    Email author
  • Meredith Smith
    • 1
  • Bonnie Spring
    • 2
  • Judith DePue
    • 3
  • William Redd
    • 1
  • Gary Winkel
    • 4
  1. 1.Department of Oncological SciencesMount Sinai School of MedicineNew YorkUSA
  2. 2.Department of Preventive MedicineNorthwestern UniversityEvanstonUSA
  3. 3.Centers for Behavioral and Preventive MedicineMiriam Hospital/Brown Medical SchoolProvidenceUSA
  4. 4.Department of PsychologyCity University of New YorkNew YorkUSA
  5. 5.Tobacco Research & Intervention ProgramH. Lee Moffitt Cancer Center & Research InstituteTampaUSA

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