Physician-delivered Smoking Cessation Research Articles

A Face-Aging App for Smoking Cessation in a Waiting Room Setting: Pilot Study in an HIV Outpatient Clinic.

BackgroundThere is strong evidence for the effectiveness of addressing tobacco use in health care settings. However, few smokers receive cessation advice when visiting a hospital. Implementing smoking cessation technology in outpatient waiting rooms could be an effective strategy for change, with the potential to expose almost all patients visiting a health care provider without preluding physician action needed.ObjectiveThe objective of this study was to develop an intervention for smoking cessation that would make use of the time patients spend in a waiting room by passively exposing them to a face-aging, public morphing, tablet-based app, to pilot the intervention in a waiting room of an HIV outpatient clinic, and to measure the perceptions of this intervention among smoking and nonsmoking HIV patients.MethodsWe developed a kiosk version of our 3-dimensional face-aging app Smokerface, which shows the user how their face would look with or without cigarette smoking 1 to 15 years in the future. We placed a tablet with the app running on a table in the middle of the waiting room of our HIV outpatient clinic, connected to a large monitor attached to the opposite wall. A researcher noted all the patients who were using the waiting room. If a patient did not initiate app use within 30 seconds of waiting time, the researcher encouraged him or her to do so. Those using the app were asked to complete a questionnaire.ResultsDuring a 19-day period, 464 patients visited the waiting room, of whom 187 (40.3%) tried the app and 179 (38.6%) completed the questionnaire. Of those who completed the questionnaire, 139 of 176 (79.0%) were men and 84 of 179 (46.9%) were smokers. Of the smokers, 55 of 81 (68%) said the intervention motivated them to quit (men: 45, 68%; women: 10, 67%); 41 (51%) said that it motivated them to discuss quitting with their doctor (men: 32, 49%; women: 9, 60%); and 72 (91%) perceived the intervention as fun (men: 57, 90%; women: 15, 94%). Of the nonsmokers, 92 (98%) said that it motivated them never to take up smoking (men: 72, 99%; women: 20, 95%). Among all patients, 102 (22.0%) watched another patient try the app without trying it themselves; thus, a total of 289 (62.3%) of the 464 patients were exposed to the intervention (average waiting time 21 minutes).ConclusionsA face-aging app implemented in a waiting room provides a novel opportunity to motivate patients visiting a health care provider to quit smoking, to address quitting at their subsequent appointment and thereby encourage physician-delivered smoking cessation, or not to take up smoking.

The effects of physician-delivered brief smoking cessation on ACRIN/NLST participants’ smoking behaviors.

7525 Background: The National Lung Screening Trial (NLST) demonstrated a 20% relative reduction in lung cancer mortality for current and former heavy smokers screened with low-dose CT vs. radiography. The NCCN and ACS recently released lung screening guidelines which promote smoking cessation counseling, but there is no information about the prevalence or effectiveness of brief physician-delivered smoking cessation interventions, such as the 5As (Ask, Advise, Assess, Assist, and Arrange follow-up) among lung screening patients. Methods: Among 8,878 NLST participants from 23 ACRIN sites who were smoking at enrollment, we conducted a longitudinal examination of the 1) rates and patterns of each reported 5A receipt and 2) association between each A and quitting. Using a case-control logistic regression, which matched participants according to trial arm; sociodemographic; medical; and smoking characteristics, we compared self-reported point-prevalence abstinence following 5A receipt. Results: Participants were 54% male, 90.6% white, and mean age 60.8 years. Receipt of 5As was consistent for the first 3 study years; rates of Ask (75%) and Advise (74%), exceeded rates of Assess (64%), Assist (58%), and Arrange follow-up (13%). Receipt of Ask, Advise, and Assess did not significantly increase the odds of a participant quitting smoking. Assist (cessation counseling, medication) increased the odds of quitting smoking by 22% (p=0.0002), and Arrange follow-up increased the odds of quitting by 20% (p=0.002). Older age and lower nicotine dependence were significantly associated with quitting, after accounting for the effectiveness of Assist (OR=1.34, CI: 1.16-1.55; OR== 0.95, CI: .93-.97) and Arrange follow-up (OR=1.34, CI: 1.16, 1.54; OR=.95, CI: .93-.97). Conclusions: Among high risk patients undergoing lung screening, Advice to quit was not associated with improved odds of smokers’ quitting. Assist and Arrange follow-up were associated with improved odds of smokers’ quitting, but unfortunately, rates of receipt of these As were low. Physician-delivered smoking cessation assistance and follow-up has the potential to enhance the effectiveness and cost effectiveness of lung screening. Clinical trial information: CDR0000257938.

A population-based examination of racial and ethnic differences in receiving physicians' advice to quit smoking

We examined the rate of physician-delivered smoking cessation advice in the United States over time for five different racial/ethnic groups. We analyzed three waves (1992--1993, 1995--1996, 1998--1999) of population-based survey data (Tobacco Use Supplement of the Current Population Survey) to examine the relationship between a smoker's race/ethnicity and past-year receipt of physician-delivered smoking cessation advice. Results of a multivariate logistic regression showed no difference in the receipt of advice as a function of a smoker's race/ethnicity in any of the surveys, with the exception of 1998--1999, after controlling for factors such as smoker's gender, years of education, household income, and cigarettes smoked per day. In the 1998--1999 survey, Asian smokers were more likely to report receiving smoking cessation advice from a physician relative to non-Hispanic White smokers. With the exception of American Indian/Alaska Native smokers, the receipt of advice by each racial/ethnic group increased significantly from the 1992--1993 survey to the 1998--1999 survey, after controlling for gender, age, education, and cigarettes smoked per day. Because rates of advice for American Indian/Alaska Native smokers did not increase over time, specific public health interventions should be developed and integrated into medical settings serving smokers from American Indian/Alaska Native communities.

Campus physicians’ tobacco interventions with university students: A descriptive study of 16 Ontario university clinics

Objective About one-quarter of Canadian post-secondary students smoke cigarettes. We examined how physicians from Ontario university health clinics intervene with these young adult smokers. Method A convenience sample of 16 universities was identified and surveys were hand-delivered to all 228 physicians from these schools. A total of 125 doctors (54.82%) responded; 70 were from universities that were involved in a government-sponsored, coordinated, multi-campus, tobacco control initiative. Results Twenty percent of doctors reported asking all or almost all patients about tobacco use; 25.22% asked fewer than half. Describing how they respond to patients identified as smokers, 96.00% of physicians advised cessation, 72.00% offered assistance, and 64.00% arranged for follow-up. Doctors discussed patients’ tobacco use with 78.59% of smokers. Nicotine replacement therapies were rarely offered to patients wanting to quit. Doctors from universities involved in the tobacco control initiative were more likely to keep patient education materials in the examining room. Conclusion Because most doctors ask only some patients about tobacco use, they may be missing opportunities to provide appropriate advice and assistance to all smokers. Practice implications Physician education and support to the clinic are needed to improve the frequency and quality of physician-delivered smoking cessation services to post-secondary students.

An academic detailing intervention to disseminate physician-delivered smoking cessation counseling: smoking cessation outcomes of the Physicians Counseling Smokers Project

Background Little is known about the effectiveness of interventions to disseminate smoking cessation interventions among a population of primary care physicians. This study’s objective was to determine the effect of a community-based academic detailing intervention on the quit rates of a population-based sample of smokers. Methods This community-based, quasi-experimental study involved representative samples of 259 primary care physicians and 4295 adult smokers. An academic detailing intervention was delivered to physicians in intervention areas over a period of 15 months. Analyses were performed on the data from the 2346 subjects who reported at least one physician visit over 24 months. Multivariate regression analyses were conducted to determine the impact of the intervention on self-reported smoking quit rates, reported by adjusted odds ratios. Results Among smokers reporting a physician visit during the study period, there was a borderline significant effect for those residing in intervention areas versus control areas (OR = 1.35; 95% CI .99–1.83; P = 0.057). Among a subgroup of 819 smokers who reported a visit with an enrolled physician, we observed a significant effect for those residing in intervention areas (OR = 1.80; 95% CI 1.16–2.75; P = 0.008). Conclusion An academic detailing intervention to enhance physician delivered smoking cessation counseling is an effective strategy for disseminating smoking cessation interventions among community-based practices.

Cost-Effectiveness Analysis of a Family Physician Delivered Smoking Cessation Program

Objectives. The objectives were to present a cost-effectiveness analysis of a smoking cessation program delivered by physicians and compare results to other smoking cessation interventions.Methods. Retrospective effectiveness figures from a previous evaluation of the smoking cessation program were supplemented with estimates based on researched assumptions. Net abstinence rates were determined for smokers, depending on their stage of readiness to quit, that is, “prepared,” “contemplative,” and “precontemplative,” leading to an assessment of the number of smokers achieving abstinence as a result of the Smokescreen intervention. Costs were calculated from the perspectives of smokers, family physicians, organizers, trainers, and all parties combined. Assumptions were varied with a sensitivity analysis.Results. Baseline costs per additional abstainer were $183 based on physicians' intervention costs at 1995 prices. This is the figure most comparable to previously conducted economic evaluations of smoking cessation interventions. Sensitivity analysis varying the perspective and under optimistic and pessimistic assumptions about effectiveness produced a wide variety of estimates. The decision to include or exclude training costs had a particularly important bearing on the estimates. However, under reasonable assumptions the cost per additional quitter compares favorably to smoking and other medical and health care interventions worldwide.Conclusions. The program appears cost-effective when compared to other smoking cessation and health promotion interventions and illustrates the potential for retrospective cost-effectiveness analysis of interventions.

Smoking withdrawal and relapse in head and neck cancer patients.

Smoking withdrawal and relapse were characterized among newly diagnosed head and neck cancer patients participating in a physician-delivered smoking cessation intervention. Patients completed questionnaires at baseline, 1, 6, and 12 months following intervention delivery. Significant baseline predictors of smoking relapse included medical treatment (XRT versus surgical treatment), stage of change/readiness to quit (precontemplators), age of initiation (younger), and greater addiction (smoking </=30 minutes after waking). Relapsers were significantly more likely to quit using gradual reduction versus cold turkey and had less confidence in remaining quit. Relapsers experienced significantly higher levels of anxiety and craving during withdrawal. Relapse was temporally delayed compared with healthy populations. Assistance with cessation efforts should be ongoing for one year and should include nicotine replacement therapy and psychotropic medications to address significant relapse triggers.

Smoking withdrawal and relapse in head and neck cancer patients

Background Smoking withdrawal and relapse were characterized among newly diagnosed head and neck cancer patients participating in a physician-delivered smoking cessation intervention. Methods Patients completed questionnaires at baseline, 1, 6, and 12 months following intervention delivery. Results Significant baseline predictors of smoking relapse included medical treatment (XRT versus surgical treatment), stage of change/readiness to quit (precontemplators), age of initiation (younger), and greater addiction (smoking ⩽30 minutes after waking). Relapsers were significantly more likely to quit using gradual reduction versus cold turkey and had less confidence in remaining quit. Relapsers experienced significantly higher levels of anxiety and craving during withdrawal. Relapse was temporally delayed compared with healthy populations. Conclusion Assistance with cessation efforts should be ongoing for one year and should include nicotine replacement therapy and psychotropic medications to address significant relapse triggers. © 1999 John Wiley & Sons, Inc. Head Neck 21: 420–427, 1999.

Effectiveness of Nicotine-Containing Gum in the Physician-Delivered Smoking Intervention Study

Background.We tested the role of nicotine-containing gum (NCG) in conjunction with brief physician counseling in smoking cessation in the Physician-Delivered Smoking Intervention Project (PDSIP).Method.Subjects were smokers randomized to the Counseling + NCG arm of the PDSIP. However, receipt and use of NCG were not randomized. Data from baseline, pharmacy records, and 6-month monitoring calls were used in these post hoc analyses.Results.Of the 299 study subjects, 57% accepted NCG and 36% of acceptors used it for more than 7 days. Predictors of NCG acceptance included high desire to quit (OR = 1.21; 95% CI 1.10, 1.35), social support to quit (OR = 1.62; 95% CI 1.01, 2.59), being a general medicine patient compared with a family practice patient (OR = 3.22; 95% CI 2.01, 5.21), and receiving the intervention from a female physician (female physician-male patient OR = 2.27; 95% CI 0.95, 5.46; female physician-female patient OR = 1.94; 95% CI 1.06, 3.57) relative to the male physician comparisons. Subjects who refilled the NCG prescription had higher cessation rates than those who did not refill or did not accept the prescription (37% vs 19% and 20%, respectively;P= 0.04). Predictors of 6-month cessation among NCG users included a previous period(s) of abstinence >3 months (OR = 1.23; 95% CI 1.04, 1.47), abstinence during illness (OR = 0.39; 95% CI 0.17, 0.86), and absence of smoking-related physical complaints the month prior to the physician-delivered intervention (OR = 0.40; 95% CI 0.17, 0.94).Conclusion.Amount of NCG use in conjunction with physician-delivered smoking cessation counseling might have contributed in helping unselected smokers quit.

Physician-delivered smoking cessation advice: issues identified during ethnographic interviews

Objective-To identify the factors that physicians believe impair their ability to provide smoking cessation advice to their patients. Design - Ethnographic interviews of physicians. Setting - Non-academic primary care practice. Subjects -18 of 27 physicians who had recently participated in the intervention group of a randomised clinical trial to increase the rate at which physicians give smoking cessation advice. Main outcome measures -Factors that the interviewees reported were affecting their ability to give smoking cessation advice. Results -The interviews generated 439 statements that we sorted into 19 cate gories. We judged 10 of the categories to be statements about medical practice and smoking in general, and nine of the categories to represent barriers to giving smoking cessation advice. The barriers described by the interviewees included: lack of patient interest, lack of physician perceived self-efficacy, lack of time, lack of organisational support, lack of reward to the physician, lack of peer support, lack of staff support, and lack of interest on the part of the physician. The com mercial promotion of tobacco was also identified as a barrier to giving smoking cessation advice. Conclusions - As reported by physicians who had participated in a trial to provide smoking cessation advice in their own practices, the barriers to giving smoking cessation advice are more than a lack of knowledge that smoking is a health hazard and the lack of skills to help the patient stop smoking. These additional barriers may need to be addressed if physicians are to improve the rates at which they identify their patients who smoke and assist them in quitting.

Patients’ Perspectives of a Physician-Delivered Smoking Cessation Intervention

Forty-three patients--recipients of a highly structured, physician-delivered smoking cessation intervention--were interviewed using ethnographic (anthropological) research methods. We conducted interviews with patients after visits with the physician, then audiotaped and transcribed them. Discourse analysis of interview texts identified features and components of the physician maneuver most effective from the patients' point of view. Patients discussed two general areas of physicians' preventive activities: an interventionistic component (in which professional, diagnostic, and authoritative features were emphasized) and a personalistic component (in which physicians were experienced as equals, supportive, caring, empowering, and challenging). From the perspective of patients, the personalistic component of the physician-delivered smoking cessation maneuver appeared most effective. We conclude that, in clinical preventive medicine generally, patients (1) evaluate the kind of support they receive from their physician (e.g., degree of empathy, encouragement, and sincerity), (2) respond favorably to positive imagery in the challenge to alter their lifestyle, (3) look for a balance in the relationship established with their physician (negotiation, respect, mutual understanding, and rapport), and (4) remember the consistency and regularity of their physician's health promotion messages.

Smoking cessation with young women in public family planning clinics: The impact of physician messages and waiting room media

This study evaluated the impact of a media program and a physician-delivered message in encouraging smoking cessation among young black women in public family planning clinics. Incorporated into the clinic visit, the 3- to 5-min physician message was intended to elicit a commitment from participants to take steps toward quitting, namely, to think about quitting, set a target date, enlist the help of family and friends, throw away matches and cigarettes, and to then quit “cold turkey.” The media program consisted of specially designed posters in waiting rooms showing models of people in the process of quitting and a continuously run movie dealing with women and smoking. A total of 1,179 female smokers were recruited into the study when they came to three separate clinics in Baltimore, Maryland, to receive gynecological examinations and/or contraceptive services. Four separate interventions were tested: (I) a baseline questionnaire about smoking habits and related information; (II) baseline questionnaire plus media program; (III) baseline questionnaire plus physician message; and (IV) baseline questionnaire plus media program plus physician message. Conditions I and II were administered in Clinic A on alternating weeks. Condition III was administered in Clinic B, and Condition IV was administered in Clinic C. Followup was conducted at 3 and 12 months. Follow-up rates were 88.1% at 3 months, 79.9% at 12 months, and 84.1% for both 3 and 12 months. Among women receiving the physician message (Conditions III and IV), 9.9% reported not smoking at 12 months; the lowest selfreported cessation rate was 3.1% in Condition I. When verified through analyzing cotinine in saliva, quit rates were 0.09% in Condition 1, 2.4% in Condition II, 3.7% in Condition III, and 2.1% in Condition IV. The fact that participants receiving the physician message quit smoking at a significantly greater rate than those who did not indicates the need for further study of the impact of physician-delivered smoking cessation messages and ways to increase their effectiveness.