Dear Editor
We are writing to describe current levels of awareness of and referral to national quitlines, and a Web-based cessation service among primary care physicians. Smokers who use telephone counseling are more likely to achieve long-term cessation compared to those who do not [1]. Quitlines can assist in forming a quit plan, offer nicotine replacement therapy, and schedule follow-up contact [2]. We analyzed data from the National Survey of Primary Care Physicians' Recommendations and Practice for Breast, Cervical, Colorectal, and Lung Cancer Screening [3] to assess awareness and referral to the National Network of Tobacco Cessation Quitlines' 1-800-QUIT-NOW, the National Cancer Institute's quitline 1-877-44U-QUIT, and the National Cancer Institute and Centers for Disease Control and Prevention Web site smokefree.gov.
The survey was fielded September 2006 to May 2007 as a mailed questionnaire. A systematic stratified random sample of non-Federal, office-based family physicians, general practitioners, general internists, and obstetrician/gynecologists aged 75 or younger was selected from the American Medical Association's Physician Masterfile. A total of 1,266 physicians completed the survey resulting in an absolute response rate of 69.3%. Further detail on sampling and survey methodology is published elsewhere [3].
Respondents were asked “Are you aware of, and have you ever referred a patient to, any of the following smoking cessation services: 1-800-QUIT-NOW; 1-877-44U-QUIT; smokefree.gov?” Physician and clinical practice characteristics included: physician race; average time per month spent teaching; number of physicians in practice; practice type (private, health system, or university); medical school affiliation; and percentage of African American patient population.
We used SUDAAN version 9.0.1 to calculate weighted percentages, odds ratios (OR), and 95% confidence intervals (CI). Respondents who reported awareness of at least one of the resources were coded as aware (n=474). Respondents who reported referral to at least one resource were coded as having made a referral (n=332). A multivariable logistic regression, including variables significantly associated (at p<0.05) with awareness or referral in bivariate analyses was conducted.
Respondents were predominantly male (68.8%), less than age 50 (50.8%), non-Hispanic White (72.1%), board-certified (80.2%) physicians practicing family medicine (45.2%), general internal medicine (36.9%), and obstetrics/gynecology (17.9%). Only 23.3% of physicians reported awareness of and referral to 1-800-QUIT-NOW. Awareness and referral to 1-877-44U-QUIT was 6.6%. Only 14.1% of physicians were aware of and reported referral to www.smokefree.gov. Nearly half of the physicians were aware of at least one national quitline or Web-based cessation service (43.6%); among these physicians, referral was 72.4%.
Awareness of at least one national quitline or Web-based cessation service was significantly associated with practice location (χ2=9.37, p=0.01), percentage of African American patient population (χ2=11.42, p=0.03), medical school affiliation (χ2=4.35, p=0.03), provider race (χ2=8.99, p=0.04), and average time spent teaching (t=2.28, p=0.03). These variables were included in a mulitivariable logistic regression model of awareness (Table 1). Compared to university-based practices, physician-owned practices were significantly less likely (OR=0.70, CI=0.50–0.99) to be aware of national smoking cessation resources. Consistent with research documenting, lower receipt of smoking cessation services among minority populations, [4–6] physicians in practices with a majority White patient population were more likely (OR=12.3, CI=2.4–64.0) to be aware of national cessation resources. Consistent with prior research documenting, higher awareness of smoking cessation resources among racial/ethnic minority physicians, [7] awareness of national quitlines and Web-based cessation services was higher among non-Hispanic Black providers (OR=2.6, CI=1.1–6.3) and providers categorized as “non-Hispanic other” (OR=1.5, CI=1.1–2.1) compared to non-Hispanic White providers.
Table 1. Factors associated with awareness of a national smoking cessation resource.
| Practice and physician characteristics (n=1,145) | Awareness OR (95% CI) |
|---|---|
| Practice type | |
| Physician-owned practice | .70 (.50–.99) |
| Health care system practice | .72 (.48–1.10) |
| University-based practice | 1.00 |
| % of African American patients | |
| 0%–5% | 9.67 (1.76–53.25) |
| 6%–25% | 12.16 (2.27–65.05) |
| 26%–50% | 12.25 (2.35–63.98) |
| 51%–75% | 4.96 (0.84–29.28) |
| 76%–100% | 1.00 |
| Affiliation with medical school | |
| Yes | 1.18 (0.87–1.60) |
| No | 1.00 |
| Race of provider | |
| Non-Hispanic Black | 2.60 (1.07–6.30) |
| Hispanic | 0.66 (0.33–1.32) |
| Non-Hispanic Other | 1.52 (1.10–2.10) |
| Non-Hispanic White | 1.00 |
| Average amount of time spent teaching during a typical month | 1.01 (.99–1.03) |
| Model Adjusted Wald F=5.55, df=12, p=0.0000 |
Efforts are needed to promote national quitlines and Web-based cessation services. Our results suggest that promotion efforts may target physician-owned practices and clinical practice settings with large minority populations.
Acknowledgments
This project has been funded in part with federal funds from the National Cancer Institute, National Institutes of Health, under contract no. HHSN261200800001E. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.
Footnotes
Competing Interests: Authors have no competing interests to disclose.
Contributor Information
Lila J. Finney Rutten, Email: finneyl@mail.nih.gov, Clinical Monitoring Research Program, SAIC-Frederick, Inc., NCI-Frederick, Frederick, MD, USA; 5705 Industry Lane, Room 201, Frederick, MD 21704, USA.
Kia Davis, Clinical Monitoring Research Program, SAIC-Frederick, Inc., NCI-Frederick, Frederick, MD, USA.
Linda Squiers, RTI International, Research Triangle Park, NC, USA.
Erik Augustson, Tobacco Control Research Branch, National Cancer Institute, Bethesda, MD, USA.
Kelly Blake, Health Communication Informatics Research Branch, National Cancer Institute, Bethesda, MD, USA.
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