Is Some Provider Advice on Smoking Cessation Better Than No Advice? An Instrumental Variable Analysis of the 2001 Health Interview Survey

Center for Community Partnerships in Health Promotion, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024-3524, USA.
Health Services Research (Impact Factor: 2.78). 12/2006; 41(6):2114-35. DOI: 10.1111/j.1475-6773.2006.00592.x
Source: PubMed


To estimate the effect of provider advice in routine clinical contacts on patient smoking cessation outcome.
The Sample Adult File from the 2001 National Health Interview Survey. We focus on adult patients who were either current smokers or quit during the last 12 months and had some contact with the health care providers or facilities they most often went to for acute or preventive care.
We estimate a joint model of self-reported smoking cessation and ever receiving advice to quit during medical visits in the past 12 months. Because providers are more likely to advise heavier smokers and/or patients already diagnosed with smoking-related conditions, we use provider advice for diet/nutrition and for physical activity reported by the same patient as instrumental variables for smoking cessation advice to mitigate the selection bias. We conduct additional analyses to examine the robustness of our estimate against the various scenarios by which the exclusion restriction of the instrumental variables may fail.
Provider advice doubles the chances of success in (self-reported) smoking cessation by their patients. The probability of quitting by the end of the 12-month reference period increased from 6.9 to 14.7 percent, an effect that is of both statistical (p < .001) and clinical significance.
Provider advice delivered in routine practice settings has a substantial effect on the success rate of smoking cessation among smoking patients. Providing advice consistently to all smoking patients, compared with routine care, is more effective than doubling the federal excise tax and, in the longer run, likely to outperform some of the other tobacco control policies such as banning smoking in private workplaces.

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Available from: Yuhua Bao, Mar 13, 2014
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    • "Given that nurses form the bulk of healthcare professionals supporting service users in mental health settings, they are critical in cessation programmes. There is sufficient evidence to indicate that nurses who offer even brief encouragement to quit smoking can have a massive impact on a service user quitting, although those with schizophrenia may require intensive interventions because of the severity of their addiction (Bao et al. 2006). The severity of addiction is a function of heaviness of smoking of these service users, which in turn is reinforced by positive effects of nicotine on their negative and positive symptoms, cognitive function and extrapyramidal side effects caused by antipsychotic medication (Barnes et al. 2006). "
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    ABSTRACT: Nicotine addiction is a public health problem that increases medical morbidity and mortality. Individuals with mental distress have higher rates of smoking and poorer cessation outcomes than those without mental distress. Individuals with schizophrenia tend to smoke more that those with other diagnostic categories. They are also more likely to smoke high-tar cigarettes than individuals with other forms of mental distress. They are therefore not only more likely to be addicted to nicotine, but they are also at an increased risk of developing serious health complications. Despite these factors, individuals with schizophrenia are generally unlikely to seek help to quit smoking, a function of decreased level of motivation and inability to do so. They are rarely involved in smoking cessation activities. Against this background, The aim of this study was to explore the effectiveness of an integrated smoking cessation programme in enabling service users to stop smoking. This article describes the application of this programme on service users with schizophrenia and nicotine addiction. It also describes roles played by its components in smoking cessation. Keywords: motivational interviewing, nicotine replacement therapy, schizophrenia, spirituality, smoking cessation
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    • "As stated by Sarna et al. (2009), evidence does indicate that nurses are effective in providing cessation interventions (Sivarajan Froelicher et al. 2004, Persson & Hjalmarson 2006, Wewers et al. 2006, Rice & Stead 2008). In fact, providing advice to smokers to stop smoking more than doubles the cessation rate (Bao et al. 2006). However, in England, there appears to be the lingering opinion that health promotion belongs to the remit of community and practice nurses, and not those in hospitals or acute settings. "
    Journal of Clinical Nursing 01/2010; 19(1-2):294-6. DOI:10.1111/j.1365-2702.2009.02975.x · 1.26 Impact Factor
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    • "Providing advice to smokers to quit more than doubles the quit rate (Bao et al. 2006). Our findings demonstrate that the majority of nurses consistently asked and advised patients to quit. "
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    ABSTRACT: To describe the frequency of nurses' delivery of tobacco cessation interventions ('Five A's': Ask, Advise, Assess, Assist, Arrange) and to determine the relationship of interventions to nurses' awareness of the Tobacco Free Nurses initiative. Tobacco cessation interventions can be effectively provided by nurses. The delivery of smoking cessation interventions by healthcare providers is mandated by several organisations in the USA and around the world. Lack of education and resources about tobacco cessation may contribute to the minimal level of interventions. The Tobacco Free Nurses initiative was developed to provide nurses with easy access to web-based resources about tobacco control. Cross-sectional survey of nurses (n = 3482) working in 35 Magnet-designated hospitals in the USA (21% response rate). A valid and reliable questionnaire used in previous studies to assess the frequency of the nurse's delivery of smoking cessation interventions ('Five A's') was adapted for use on the web. The majority of nurses asked (73%) and assisted (73%) with cessation. However, only 24% recommended pharmacotherapy. Only 22% referred to community resources and only 10% recommended use of the quitline. Nurses familiar with TFN (15%) were significantly more likely to report delivery of all aspects of interventions, including assisting with cessation (OR = 1.55, 95% CI 1.27, 1.90) and recommending medications (OR = 1.81, 95% CI 1.45, 2.24). Nurses' delivery of comprehensive smoking cessation interventions was suboptimal. Awareness of Tobacco Free Nurses was associated with increased interventions. Relevance to clinical practice. Further efforts are needed to ensure that nurses incorporate evidence-based interventions into clinical practice to help smokers quit. These findings support the value of Tobacco Free Nurses in providing nurses with information to support patients' quit attempts.
    Journal of Clinical Nursing 08/2009; 18(14):2066-77. DOI:10.1111/j.1365-2702.2009.02796.x · 1.26 Impact Factor
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