Smokers Ages 50+: Who Gets Physician Advice to Quit?
ABSTRACT Smoking-related morbidity and mortality, and benefits associated with quitting, extend across the life span. Health care provider interventions enhance quitting. The present study examined perceived influence of physician advice to quit and characteristics of subjects receiving this advice.
Subjects were 1,454 smokers ages 50+ with at least one physician visit in the past year. Subjects were surveyed at baseline for receipt of and reactions to physician advice to quit and for smoking, health, and demographic characteristics.
Over half of subjects welcomed physician advice to quit, about half said the advice influenced their quitting decision "extremely" or "quite a lot," and about one-third indicated that it increased their confidence in quitting. Physicians were more likely to advise sicker patients, indicated by poorer health status, at least one past year hospitalization, and presence of cardiovascular, cerebrovascular, or respiratory diseases.
Midlife and older smokers reacted generally favorably to physician advice to quit. Physicians were more likely to advise patients with commonly recognized smoking-related diseases. Discrepancies were noted in advice given to sicker vs healthier patients. Additional physician training in less commonly recognized smoking-related illnesses, intervening with healthier patients to prevent disease, and enhancing patients' confidence in quitting may improve outcomes.
- SourceAvailable from: PubMed Central
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- "The majority of tobacco users (81.5%) knew the importance of being advised and reported that being advised could help them quit tobacco use. Since smokers have been documented to respond favorably to their physicians' advice,  not screening patients for and advising patients against tobacco use constitute serious omissions, with both clinical and public health implications. Screening and providing brief cessation advice improve the probability of patients' quitting tobacco use and has the potential to decrease the several thousand deaths from tobacco use, allowing for a rechanneling of resources expended on the treatment of tobacco-related diseases to other more pressing health needs, such as HIV and AIDS treatment. "
ABSTRACT: Primary health care (PHC) settings offer opportunities for tobacco use screening and brief cessation advice, but data on such activities in South Africa are limited. The aim of this study was to determine the extent to which participants were screened for and advised against tobacco use during consultations. This cross-sectional study involved 500 participants, 18 years and older, attended by doctors or PHC nurses. Using an exit-interview questionnaire, information was obtained on participants' tobacco use status, reason(s) for seeking medical care, whether participants had been screened for and advised about their tobacco use and patients' level of comfort about being asked about and advised to quit tobacco use. Main outcome measures included patients' self-reports on having been screened and advised about tobacco use during their current clinic visit and/or any other visit within the last year. Data analysis included the use of chi-square statistics, t-tests and multiple logistic regression analysis. Of the 500 participants, 14.9% were current smokers and 12.1% were smokeless tobacco users. Only 12.9% of the participants were screened for tobacco use during their current visit, indicating the vast majority were not screened. Among the 134 tobacco users, 11.9% reported being advised against tobacco use during the current visit and 35.1% during any other visit within the last year. Of the participants not screened, 88% indicated they would be 'very comfortable' with being screened. A pregnancy-related clinic visit was the single most significant predictor for being screened during the current clinic visit (OR = 4.59; 95%CI = 2.13-9.88). Opportunities for tobacco use screening and brief cessation advice were largely missed by clinicians. Incorporating tobacco use status into the clinical vital signs as is done for pregnant patients during antenatal care visits in South Africa has the potential to improve tobacco use screening rates and subsequent cessation.BMC Family Practice 11/2010; 11(1):94. DOI:10.1186/1471-2296-11-94 · 1.67 Impact Factor
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- "In this paper we report the short-term outcomes of a randomized controlled trial of a strategy to offer telephone-based cessation counseling to health plan members who smoked and who did or did not have smoking-related chronic diseases. We included a study arm of smoking members with chronic diseases because other studies have shown that these patients are significantly more likely to be counseled by physicians and because cessation is particularly important for them (Jaen, Crabtree, Zyzanski, Goodwin, & Stange, 1997; Jaen, Stange, Tumiel, & Nutting, 1998; Thorndike, Rigotti, Stafford, & Singer, 1998; Ossip-Klein et al., 2000). We hypothesized that, compared with a control group, providing proactive telephone counseling would increase use of the medication, quit attempts, and smoking cessation rates among health plan members filling a prescription for covered smoking cessation medications. "
ABSTRACT: Whereas telephone-based counseling has been found to be effective in supporting smokers interested in quitting smoking, it is not known whether proactive efforts to reach smokers receiving cessation medications will enhance their likelihood of successful quitting. We had an opportunity to test, in a health plan setting, an offer of telephone-based counseling with smokers identified from health plan records as recently filling a prescription for nicotine replacement therapy or bupropion. After we removed 31 members determined to be ineligible, 1,329 were randomly allocated to receive an invitation either to telephone-based counseling (n = 663) or to a control group (n = 666). On average, 7 days (range = 3-15 days) elapsed from the day of the prescription fill until the Center for Health Promotion began calling to invite members to participate in telephone counseling. The Center for Health Promotion was able to reach 49% of those in the intervention group (323/663). Of these members, 118 (37%) declined any participation. Therefore, in response to the proactive contact, 63% (205/323) of those reached and 31% (205/663) of those eligible participated in some smoking cessation counseling. At the 3-month follow-up, we observed an increased quit rate (33.1% vs. 27.4%) among health plan members randomized to telephone-based smoking cessation counseling. The results varied by gender and amount smoked. In addition, the variables associated with quitting in a multivariate logistic regression model included older age and using more than 30 days of medication.Nicotine & Tobacco Research 05/2005; 7 Suppl 1(2):S19-27. DOI:10.1080/14622200500078048 · 3.30 Impact Factor
- "Goldstein et al. (1998), in a survey of a representative sample of primary-care physicians, report that 67 percent ask and 74 percent advise their patients about smoking. A recent survey of older smokers (ages 50 and up) finds that over 80 percent of those who were advised to quit said that the advice influenced their quitting decision " extremely " or " quite a lot " and that it increased their confidence in quitting (Ossip-Klein et al., 2000). Lancaster and Stead "
Article: Medicare and Health Behaviors[Show abstract] [Hide abstract]
ABSTRACT: Basic economic theory suggests that health insurance coverage may cause a reduction in prevention activities, but empirical studies have yet to provide evidence to support this prediction. However, in other insurance contexts that involve adverse health events, evidence of ex ante moral hazard is more consistent. In this paper, we extend the analysis of the effect of health insurance on health behaviors by allowing for the possibility that health insurance has a direct (ex ante moral hazard) and indirect effect on health behaviors. The indirect effect works through changes in health promotion information and the probability of illness that may be a byproduct of insurance-induced greater contact with medical professionals. We identify these two effects and in doing so identify the pure ex ante moral hazard effect. We find limited evidence that obtaining health insurance reduces prevention and increases unhealthy behaviors among elderly persons.