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Predictors of Physicians' Smoking Cessation Advice

Erica Frank, MD, MPH; Marilyn A. Winkleby, PhD; David G. Altman, PhD; Beverly Rockhill, MA; Stephen P. Fortmann, MD
JAMA. 1991;266(22):3139-3144. doi:10.1001/jama.1991.03470220055026.
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Objectives.  —To determine the percentage of smokers reporting that a physician had ever advised them to smoke less or to stop smoking, and the effect of time, demographics, medical history, and cigarette dependence on the likelihood that respondents would state that a physician had ever advised them to stop smoking.

Design and Setting.  —Data were collected from the Stanford Five-City Project, a communitywide health education intervention program. The two treatment and three control cities were located in northern and central California. As there was no significant difference between treatment and control cities regarding cessation advice, data were pooled for these analyses.

Participants.  —There were five cross-sectional, population-based Five-City Project surveys (conducted in 1979-1980, 1981-1982, 1983-1984, 1985-1986, and 1989-1990); these surveys randomly sampled households and included all residents aged 12 to 74 years.

Main Outcome Measures.  —Improved smoking advice rates over time in all towns was an a priori hypothesis.

Results.  —Of the 2710 current smokers, 48.8% stated that their physicians had ever advised them to smoke less or stop smoking. Respondents were more likely to have been so advised if they smoked more cigarettes per day, were surveyed later in the decade, had more office visits in the last year, or were older. In 1979-1980, 44.1% of smokers stated that they had ever been advised to smoke less or to quit by a physician, vs 49.8% of smokers in 1989-1990 (P<.07). Only 3.6% of 1672 ex-smokers stated that their physicians had helped them quit.

Conclusion.  —These findings suggest that physicians still need to increase smoking cessation counseling to all patients, particularly adolescents and other young smokers, minorities, and those without cigarette-related disease.(JAMA. 1991;266:3139-3144)


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