Skip to main content
PMC home page
Journal of the National Medical Association logoLink to Journal of the National Medical Association
. 1997 Aug;89(8):534–542.

African-American physicians and smoking cessation counseling.

B A Berman 1, A K Yancey 1, R Bastani 1, S C Grosser 1, A Staveren 1, R A Williams 1, D Lee 1
PMCID: PMC2568123  PMID: 9264221

Abstract

While African American physicians can play a key role in encouraging black patients who smoke to quit, little is known about the views and activities of these physicians with respect to antitobacco programming. In the process of developing a protocol for encouraging physicians' smoking cessation intervention, 96 African-American physicians completed a survey indicating their knowledge, attitudes, and practices relating to stop smoking counseling. Few physicians reported patient help-seeking behavior and 47.9% cited lack of patient motivation as a key barrier to intervention. Only 46.8% believed that it is possible to accomplish a lot of cessation help in a few minutes time, and 34.4% believed that setting up and maintaining an office protocol would require a great deal of effort. Explaining health risks (71.9%) and enrolling patients in programs (66.6%) were perceived as keys to patient cessation; fewer than half of the physicians surveyed discuss specific strategies for quitting with their patients. Physicians indicated a willingness to offer more counseling in the future and were open to a range of strategies for learning more about effective approaches. Our findings support the need for dissemination of such information, particularly among specialists, to support antitobacco efforts among African-American physicians.

Full text

PDF
534

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anda R. F., Remington P. L., Sienko D. G., Davis R. M. Are physicians advising smokers to quit? The patient's perspective. JAMA. 1987 Apr 10;257(14):1916–1919. [PubMed] [Google Scholar]
  2. Baker D. W., Stevens C. D., Brook R. H. Regular source of ambulatory care and medical care utilization by patients presenting to a public hospital emergency department. JAMA. 1994 Jun 22;271(24):1909–1912. [PubMed] [Google Scholar]
  3. Bal D. G., Lloyd J. C., Manley M. W. The role of the primary care physician in tobacco use prevention and cessation. CA Cancer J Clin. 1995 Nov-Dec;45(6):369–374. doi: 10.3322/canjclin.45.6.369. [DOI] [PubMed] [Google Scholar]
  4. Brink S. G., Gottlieb N. H., McLeroy K. R., Wisotzky M., Burdine J. N. A community view of smoking cessation counseling in the practices of physicians and dentists. Public Health Rep. 1994 Jan-Feb;109(1):135–142. [PMC free article] [PubMed] [Google Scholar]
  5. Bristow L. R. Mine eyes have seen. JAMA. 1989 Jan 13;261(2):284–285. [PubMed] [Google Scholar]
  6. Brownson R. C., Jackson-Thompson J., Wilkerson J. C., Davis J. R., Owens N. W., Fisher E. B., Jr Demographic and socioeconomic differences in beliefs about the health effects of smoking. Am J Public Health. 1992 Jan;82(1):99–103. doi: 10.2105/ajph.82.1.99. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Centers for Disease Control and Prevention (CDC) Cigarette smoking among adults--United States, 1993. MMWR Morb Mortal Wkly Rep. 1994 Dec 23;43(50):925–930. [PubMed] [Google Scholar]
  8. Centers for Disease Control and Prevention (CDC) Physician and other health-care professional counseling of smokers to quit--United States, 1991. MMWR Morb Mortal Wkly Rep. 1993 Nov 12;42(44):854–857. [PubMed] [Google Scholar]
  9. Centers for Disease Control and Prevention (CDC) Tobacco use and usual source of cigarettes among high school students--United States, 1995. MMWR Morb Mortal Wkly Rep. 1996 May 24;45(20):413–418. [PubMed] [Google Scholar]
  10. Cummings S. R., Stein M. J., Hansen B., Richard R. J., Gerbert B., Coates T. J. Smoking counseling and preventive medicine. A survey of internists in private practices and a health maintenance organization. Arch Intern Med. 1989 Feb;149(2):345–349. doi: 10.1001/archinte.149.2.345. [DOI] [PubMed] [Google Scholar]
  11. Davis R. M. Current trends in cigarette advertising and marketing. N Engl J Med. 1987 Mar 19;316(12):725–732. doi: 10.1056/NEJM198703193161206. [DOI] [PubMed] [Google Scholar]
  12. Duncan C., Stein M. J., Cummings S. R. Staff involvement and special follow-up time increase physicians' counseling about smoking cessation: a controlled trial. Am J Public Health. 1991 Jul;81(7):899–901. doi: 10.2105/ajph.81.7.899. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Fiore M. C., Novotny T. E., Pierce J. P., Hatziandreu E. J., Patel K. M., Davis R. M. Trends in cigarette smoking in the United States. The changing influence of gender and race. JAMA. 1989 Jan 6;261(1):49–55. [PubMed] [Google Scholar]
  14. Frank E., Winkleby M. A., Altman D. G., Rockhill B., Fortmann S. P. Predictors of physician's smoking cessation advice. JAMA. 1991 Dec 11;266(22):3139–3144. [PubMed] [Google Scholar]
  15. Franklin J. L., Williams A. F., Kresch G. M., Painter J. T., Torges K., White J., Grossman O. Smoking cessation interventions by family physicians in Texas. Tex Med. 1992 Nov;88(11):60–64. [PubMed] [Google Scholar]
  16. Frankowski B. L., Secker-Walker R. H. Advising parents to stop smoking. Opportunities and barriers in pediatric practice. Am J Dis Child. 1989 Sep;143(9):1091–1094. doi: 10.1001/archpedi.1989.02150210127032. [DOI] [PubMed] [Google Scholar]
  17. Frankowski B. L., Weaver S. O., Secker-Walker R. H. Advising parents to stop smoking: pediatricians' and parents' attitudes. Pediatrics. 1993 Feb;91(2):296–300. [PubMed] [Google Scholar]
  18. Freeman H. Race, poverty, and cancer. J Natl Cancer Inst. 1991 Apr 17;83(8):526–527. doi: 10.1093/jnci/83.8.526. [DOI] [PubMed] [Google Scholar]
  19. Garfinkel L. The epidemiology of cancer in black Americans. Stat Bull Metrop Insur Co. 1991 Apr-Jun;72(2):11–17. [PubMed] [Google Scholar]
  20. Gemson D. H., Elinson J., Messeri P. Differences in physician prevention practice patterns for white and minority patients. J Community Health. 1988 Spring;13(1):53–64. doi: 10.1007/BF01321480. [DOI] [PubMed] [Google Scholar]
  21. Gillum R. F. Chronic obstructive pulmonary disease in blacks and whites: pulmonary function norms and risk factors. J Natl Med Assoc. 1991 May;83(5):393–401. [PMC free article] [PubMed] [Google Scholar]
  22. Gilpin E. A., Pierce J. P., Johnson M., Bal D. Physician advice to quit smoking: results from the 1990 California Tobacco Survey. J Gen Intern Med. 1993 Oct;8(10):549–553. doi: 10.1007/BF02599637. [DOI] [PubMed] [Google Scholar]
  23. Giovino G. A., Schooley M. W., Zhu B. P., Chrismon J. H., Tomar S. L., Peddicord J. P., Merritt R. K., Husten C. G., Eriksen M. P. Surveillance for selected tobacco-use behaviors--United States, 1900-1994. MMWR CDC Surveill Summ. 1994 Nov 18;43(3):1–43. [PubMed] [Google Scholar]
  24. Glynn T. J., Manley M. W., Pechacek T. F. Physician-initiated smoking cessation program: the National Cancer Institute trials. Prog Clin Biol Res. 1990;339:11–25. [PubMed] [Google Scholar]
  25. Goldberg R. J., Ockene I. S., Ockene J. K., Merriam P., Kristeller J. Physicians' attitudes and reported practices toward smoking intervention. J Cancer Educ. 1993 Summer;8(2):133–139. doi: 10.1080/08858199309528220. [DOI] [PubMed] [Google Scholar]
  26. Hahn L. P., Folsom A. R., Sprafka J. M., Norsted S. W. Cigarette smoking and cessation behaviors among urban blacks and whites. Public Health Rep. 1990 May-Jun;105(3):290–295. [PMC free article] [PubMed] [Google Scholar]
  27. Haynes M. A. Making cancer prevention effective for African-Americans. Stat Bull Metrop Insur Co. 1991 Apr-Jun;72(2):18–22. [PubMed] [Google Scholar]
  28. Hoffman A., Cooper R., Lacey L., Mullner R. Cigarette smoking and attitudes toward quitting among black patients. J Natl Med Assoc. 1989 Apr;81(4):415–420. [PMC free article] [PubMed] [Google Scholar]
  29. Hollis J. F., Lichtenstein E., Vogt T. M., Stevens V. J., Biglan A. Nurse-assisted counseling for smokers in primary care. Ann Intern Med. 1993 Apr 1;118(7):521–525. doi: 10.7326/0003-4819-118-7-199304010-00006. [DOI] [PubMed] [Google Scholar]
  30. Hymowitz N., Sexton M., Ockene J., Grandits G. Baseline factors associated with smoking cessation and relapse. MRFIT Research Group. Prev Med. 1991 Sep;20(5):590–601. doi: 10.1016/0091-7435(91)90057-b. [DOI] [PubMed] [Google Scholar]
  31. Kabat G. C., Morabia A., Wynder E. L. Comparison of smoking habits of blacks and whites in a case-control study. Am J Public Health. 1991 Nov;81(11):1483–1486. doi: 10.2105/ajph.81.11.1483. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Kottke T. E., Battista R. N., DeFriese G. H., Brekke M. L. Attributes of successful smoking cessation interventions in medical practice. A meta-analysis of 39 controlled trials. JAMA. 1988 May 20;259(19):2883–2889. doi: 10.1001/jama.259.19.2883. [DOI] [PubMed] [Google Scholar]
  33. Kottke T. E., Solberg L. I., Brekke M. L., Conn S. A., Maxwell P., Brekke M. J. A controlled trial to integrate smoking cessation advice into primary care practice: Doctors Helping Smokers, Round III. J Fam Pract. 1992 Jun;34(6):701–708. [PubMed] [Google Scholar]
  34. Lindsay E. A., Ockene J. K., Hymowitz N., Giffen C., Berger L., Pomrehn P. Physicians and smoking cessation. A survey of office procedures and practices in the Community Intervention Trial for Smoking Cessation. Arch Fam Med. 1994 Apr;3(4):341–348. doi: 10.1001/archfami.3.4.341. [DOI] [PubMed] [Google Scholar]
  35. Manfredi C., Lacey L., Warnecke R., Buis M. Smoking-related behavior, beliefs, and social environment of young black women in subsidized public housing in Chicago. Am J Public Health. 1992 Feb;82(2):267–272. doi: 10.2105/ajph.82.2.267. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Manley M., Epps R. P., Husten C., Glynn T., Shopland D. Clinical interventions in tobacco control. A National Cancer Institute training program for physicians. JAMA. 1991 Dec 11;266(22):3172–3173. [PubMed] [Google Scholar]
  37. McPhee S. J., Detmer W. M. Office-based interventions to improve delivery of cancer prevention services by primary care physicians. Cancer. 1993 Aug 1;72(3 Suppl):1100–1112. doi: 10.1002/1097-0142(19930801)72:3+<1100::aid-cncr2820721327>3.0.co;2-n. [DOI] [PubMed] [Google Scholar]
  38. Michels P. J., Keisler D. Psychological, demographic and situational factors of family physicians which influence cigarette cessation interventions in office-based practice. Patient Educ Couns. 1994 Aug;24(1):63–71. doi: 10.1016/0738-3991(94)90026-4. [DOI] [PubMed] [Google Scholar]
  39. Montner P., Bennett G., Brown C. An evaluation of a smoking cessation training program for medical residents in an inner-city hospital. J Natl Med Assoc. 1994 Sep;86(9):671–675. [PMC free article] [PubMed] [Google Scholar]
  40. Moy E., Bartman B. A. Physician race and care of minority and medically indigent patients. JAMA. 1995 May 17;273(19):1515–1520. [PubMed] [Google Scholar]
  41. Mullen P. D., Tabak E. R. Patterns of counseling techniques used by family practice physicians for smoking, weight, exercise, and stress. Med Care. 1989 Jul;27(7):694–704. doi: 10.1097/00005650-198907000-00004. [DOI] [PubMed] [Google Scholar]
  42. Novotny T. E., Warner K. E., Kendrick J. S., Remington P. L. Smoking by blacks and whites: socioeconomic and demographic differences. Am J Public Health. 1988 Sep;78(9):1187–1189. doi: 10.2105/ajph.78.9.1187. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Ockene J. K., Aney J., Goldberg R. J., Klar J. M., Williams J. W. A survey of Massachusetts physicians' smoking intervention practices. Am J Prev Med. 1988 Jan-Feb;4(1):14–20. [PubMed] [Google Scholar]
  44. Ockene J. K., Kristeller J., Pbert L., Hebert J. R., Luippold R., Goldberg R. J., Landon J., Kalan K. The physician-delivered smoking intervention project: can short-term interventions produce long-term effects for a general outpatient population? Health Psychol. 1994 May;13(3):278–281. doi: 10.1037//0278-6133.13.3.278. [DOI] [PubMed] [Google Scholar]
  45. Ockene J. K. Physician-delivered interventions for smoking cessation: strategies for increasing effectiveness. Prev Med. 1987 Sep;16(5):723–737. doi: 10.1016/0091-7435(87)90054-5. [DOI] [PubMed] [Google Scholar]
  46. Orleans C. T., George L. K., Houpt J. L., Brodie K. H. Health promotion in primary care: a survey of U.S. family practitioners. Prev Med. 1985 Sep;14(5):636–647. doi: 10.1016/0091-7435(85)90083-0. [DOI] [PubMed] [Google Scholar]
  47. Orleans C. T., Schoenbach V. J., Salmon M. A., Strecher V. J., Kalsbeek W., Quade D., Brooks E. F., Konrad T. R., Blackmon C., Watts C. D. A survey of smoking and quitting patterns among black Americans. Am J Public Health. 1989 Feb;79(2):176–181. doi: 10.2105/ajph.79.2.176. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Paul E. A., Gemson D. H. Nondrug treatment of hypertension: a survey of black physicians in New York State. J Natl Med Assoc. 1989 Dec;81(12):1233–1239. [PMC free article] [PubMed] [Google Scholar]
  49. Pierce J. P., Fiore M. C., Novotny T. E., Hatziandreu E. J., Davis R. M. Trends in cigarette smoking in the United States. Educational differences are increasing. JAMA. 1989 Jan 6;261(1):56–60. [PubMed] [Google Scholar]
  50. Pierce J. P., Fiore M. C., Novotny T. E., Hatziandreu E. J., Davis R. M. Trends in cigarette smoking in the United States. Projections to the year 2000. JAMA. 1989 Jan 6;261(1):61–65. [PubMed] [Google Scholar]
  51. Quirk M., Ockene J., Kristeller J., Goldberg R., Donnelly G., Amick T., Kalan K. Training family practice and internal medicine residents to counsel patients who smoke: improvement and retention of counseling skills. Fam Med. 1991 Feb;23(2):108–111. [PubMed] [Google Scholar]
  52. Romano P. S., Bloom J., Syme S. L. Smoking, social support, and hassles in an urban African-American community. Am J Public Health. 1991 Nov;81(11):1415–1422. doi: 10.2105/ajph.81.11.1415. [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Royce J. M., Ashford A., Resnicow K., Freeman H. P., Caesar A. A., Orlandi M. A. Physician- and nurse-assisted smoking cessation in Harlem. J Natl Med Assoc. 1995 Apr;87(4):291–300. [PMC free article] [PubMed] [Google Scholar]
  54. Royce J. M., Hymowitz N., Corbett K., Hartwell T. D., Orlandi M. A. Smoking cessation factors among African Americans and whites. COMMIT Research Group. Am J Public Health. 1993 Feb;83(2):220–226. doi: 10.2105/ajph.83.2.220. [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Shervington D. O. Attitudes and practices of African-American women regarding cigarette smoking: implications for interventions. J Natl Med Assoc. 1994 May;86(5):337–343. [PMC free article] [PubMed] [Google Scholar]
  56. Solberg L. I. Do physicians need assistance to help smokers quit? Fam Pract Res J. 1992 Sep;12(3):231–234. [PubMed] [Google Scholar]
  57. Solberg L. I., Maxwell P. L., Kottke T. E., Gepner G. J., Brekke M. L. A systematic primary care office-based smoking cessation program. J Fam Pract. 1990 Jun;30(6):647–654. [PubMed] [Google Scholar]
  58. Stillman F. A., Bone L. R., Rand C., Levine D. M., Becker D. M. Heart, body, and soul: a church-based smoking-cessation program for Urban African Americans. Prev Med. 1993 May;22(3):335–349. doi: 10.1006/pmed.1993.1028. [DOI] [PubMed] [Google Scholar]
  59. Stotts R. C., Glynn T. J., Baquet C. R. Smoking cessation among blacks. J Health Care Poor Underserved. 1991 Fall;2(2):307–319. doi: 10.1353/hpu.2010.0148. [DOI] [PubMed] [Google Scholar]
  60. Tuckson R. V. Race, sex, economics, and tobacco advertising. J Natl Med Assoc. 1989 Nov;81(11):1119–1124. [PMC free article] [PubMed] [Google Scholar]
  61. Vander Martin R., Cummings S. R., Coates T. J. Ethnicity and smoking: differences in white, black, Hispanic, and Asian medical patients who smoke. Am J Prev Med. 1990 Jul-Aug;6(4):194–199. [PubMed] [Google Scholar]
  62. Wagenknecht L. E., Perkins L. L., Cutter G. R., Sidney S., Burke G. L., Manolio T. A., Jacobs D. R., Jr, Liu K. A., Friedman G. D., Hughes G. H. Cigarette smoking behavior is strongly related to educational status: the CARDIA study. Prev Med. 1990 Mar;19(2):158–169. doi: 10.1016/0091-7435(90)90017-e. [DOI] [PubMed] [Google Scholar]
  63. Wechsler H., Levine S., Idelson R. K., Rohman M., Taylor J. O. The physician's role in health promotion--a survey of primary-care practitioners. N Engl J Med. 1983 Jan 13;308(2):97–100. doi: 10.1056/NEJM198301133080211. [DOI] [PubMed] [Google Scholar]
  64. Young R. L., Crooks C., Elder J. P., Kenney E., Bal D. G., Johnson M. Smoking cessation attitudes, practices, and policies among California primary care physicians. West J Med. 1991 Nov;155(5):548–549. [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of the National Medical Association are provided here courtesy of National Medical Association

RESOURCES