Abstract
Objective
Smoking cessation counseling practices may differ between physicians who smoke and those who have quit or never smoked.
Method
Of 917 general practitioners (GP) in Montreal mailed self-report questionnaires in 2000 and 2004, 610 provided data on their smoking status and counseling practices.
Results
Seven percent were current smokers, 32% were former smokers, and 61% were never-smokers. Current smokers were more interested than never- or former smokers in learning about counseling methods (64%, 56%, 45%, respectively; p=0.018). In multivariable analyses, current smokers were less likely than never-smokers to ascertain the smoking status of their patients (OR 0.6, 95% CI 0.2–1.6); to provide advice on how to quit (OR 0.6, 0.3–1.3); and to provide complete cessation counseling coverage (OR 0.5, 0.2–1.1). Former smokers were more likely to provide adjunct support (OR 1.5, 1.0–2.4).
Conclusion
GP smoking status was associated with the content of their cessation interventions with patients who smoke. Taking physician smoking status into consideration in the design of cessation training programs may improve cessation counseling interventions.
Key words: Physician smoking, cessation counseling, cross-sectional, mail questionnaire, logistic regression
Résumé
Objectif
Déceler les différences éventuelles dans les pratiques de counseling en abandon du tabac des médecins qui fument et de ceux qui ont arrêté ou qui n’ont jamais fumé.
Méthode
Sur 917 omnipraticiens de Montréal à qui nous avons posté des questionnaires d’auto-évaluation en 2000 et en 2004, 610 ont fourni des données sur leur usage du tabac et leurs pratiques de counseling.
Résultats
Sept p. cent des répondants étaient des fumeurs actuels, 32 % étaient d’anciens fumeurs et 61 % n’avaient jamais fumé. Les fumeurs actuels étaient plus intéressés par l’apprentissage des méthodes de counseling que les répondants n’ayant jamais fumé ou ayant cessé de fumer (64 %, 56 % et 45 %, respectivement; p=0,018). Selon une analyse multivariée, les fumeurs actuels étaient moins susceptibles que les répondants n’ayant jamais fumé de vérifier si leurs patients fumaient ou non (RC = 0,6, IC de 95 % = 0,2–1,6); de donner des conseils sur l’arrêt du tabac (RC = 0,6, 0,3–1,3); et de proposer des services complets de counseling en abandon du tabac (RC = 0,5, 0,2–1,1). Les anciens fumeurs étaient plus susceptibles de proposer des services complémentaires (RC = 1,5, 1,0–2,4).
Conclusion
L’usage du tabac par les omnipraticiens était associé à la nature de leurs interventions auprès des patients fumeurs. En tenant compte du tabagisme des médecins dans la conception des programmes de formation en abandon du tabac, il serait possible d’améliorer les interventions de counseling.
Mots clés: tabagisme des médecins, counseling en abandon du tabac, études transversales, questionnaire postal, analyse de régression logistique
Footnotes
Conflict of Interest: None to declare.
References
- 1.Fiore MC, Jaén CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, et al. Treating Tobacco Use and Dependence: 2008 Update, Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services; 2008. [Google Scholar]
- 2.World Health Organization: WHO Tobacco Free Initiative: The Role of Health Professionals in Tobacco Control. Geneva, Switzerland: WHO, 2005.
- 3.Smoking-Cessation Advice from Health-Care Providers — Canada, 2005. MMWR 2007;56(28):708-12. Available at: https://doi.org/www.cdc.gov/mmwr/preview/mmwrhtml/mm5628a3.htm (Accessed January 6, 2010). [PubMed]
- 4.Squier C, Hesli V, Lowe J, Ponamorenko V, Medvedovskaya N. Tobacco use, cessation advice to patients and attitudes to tobacco control among physicians in Ukraine. Eur J Cancer Prev. 2006;15(5):458–63. doi: 10.1097/00008469-200610000-00012. [DOI] [PubMed] [Google Scholar]
- 5.Barengo NC, Sandstrom HP, Jormanainen VJ, Myllykangas MT. Attitudes and behaviors in smoking cessation among general practitioners in Finland 2001. Soz Praventivmedn. 2005;50(6):355–60. doi: 10.1007/s00038-005-4097-z. [DOI] [PubMed] [Google Scholar]
- 6.Tremblay M, Gervais A, Lacroix C, O’Loughlin J, Makni H, Paradis G. Physicians taking action against smoking: An intervention program to optimize smoking cessation counseling by Montreal general practitioners. CMAJ. 2001;165(5):601–7. [PMC free article] [PubMed] [Google Scholar]
- 7.Goldstein MG, DePue JD, Monroe AD, Lessne CW, Rakowski W, Prokhorov A, et al. A population-based survey of physician smoking cessation counseling practices. Prev Med. 1998;27(5Pt1):720–29. doi: 10.1006/pmed.1998.0350. [DOI] [PubMed] [Google Scholar]
- 8.O’Loughlin J, Makni H, Tremblay M, Lacroix C, Gervais A, Dery V, et al. Smoking cessation counseling practices of general practitioners in Montreal. Prev Med. 2001;33(6):627–38. doi: 10.1006/pmed.2001.0937. [DOI] [PubMed] [Google Scholar]
- 9.Vogt F, Hall S, Marteau TM. General practitioners’ and family physicians’ negative beliefs and attitudes towards discussing smoking cessation with patients: A systematic review. Addiction. 2005;100(10):1423–31. doi: 10.1111/j.1360-0443.2005.01221.x. [DOI] [PubMed] [Google Scholar]
- 10.Vogt F, Hall S, Marteau TM. General practitioners’ beliefs about effectiveness and intentions to recommend smoking cessation services: Qualitative and quantitative studies. BMC Family Practice. 2007;8:39–50. doi: 10.1186/1471-2296-8-39. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Meredith LS, Yano EM, Hickey SC, Sherman SE. Primary care provider attitudes are associated with smoking cessation counseling and referral. Medical Care. 2005;43:929–34. doi: 10.1097/01.mlr.0000173566.01877.ac. [DOI] [PubMed] [Google Scholar]
- 12.Josseran L, King G, Guilbert P, Davis J, Brucker G. Smoking by French general practitioners: Behaviour, attitudes and practice. Eur J Public Health. 2005;15(1):33–38. doi: 10.1093/eurpub/cki108. [DOI] [PubMed] [Google Scholar]
- 13.Coleman T, Murphy E, Cheater F. Factors influencing discussion of smoking between general practitioners and patients who smoke: A qualitative study. Br J Gen Pract. 2000;50(452):207–10. [PMC free article] [PubMed] [Google Scholar]
- 14.Pollak KI, Arredondo EM, Yarnall KS, Lipkus I, Myers E, McNeilly M, Costanzo P. How do residents prioritize smoking cessation for young “high-risk” women? Factors associated with addressing smoking cessation. Prev Med. 2001;33(4):292–99. doi: 10.1006/pmed.2001.0884. [DOI] [PubMed] [Google Scholar]
- 15.Cornuz J, Humair JP, Seematter L, Stoianov R, van Melle G, Stalder H, Pecoud A. Efficacy of resident training in smoking cessation: A randomized, controlled trial of a program based on application of behavioral theory and practice with standardized patients. Ann Intern Med. 2002;136(6):429–37. doi: 10.7326/0003-4819-136-6-200203190-00006. [DOI] [PubMed] [Google Scholar]
- 16.Malarcher A, Easton A, Husten C, Frank E. Smoking cessation counselling: Training and practice among women pediatricians. Clinical Pediatrics. 2002;41(5):341–49. doi: 10.1177/000992280204100507. [DOI] [PubMed] [Google Scholar]
- 17.Kawakami M, Nakamura S, Fumimoto H, Takizawa J, Baba M. Relationship between smoking status of physicians and their enthusiasm to offer smoking cessation advice. Intern Med. 1997;36(3):162–65. doi: 10.2169/internalmedicine.36.162. [DOI] [PubMed] [Google Scholar]
- 18.Ohida T, Sakurai H, Mochizuki Y, Kamal AM, Takemura S, Minowa M, Kawahara K. Smoking prevalence and attitudes towards smoking among Japanese physicians. JAMA. 2001;285(20):2643–48. doi: 10.1001/jama.285.20.2643. [DOI] [PubMed] [Google Scholar]
- 19.Underner M, Ingrand R, Allouch A, Laforgue AV, Migeot V, Defossez G, Meurice JCl. Influence of smoking among family physicians on their practice of giving minimal smoking cessation advice. Rev Mal Respir. 2006;23(5Pt1):426–29. doi: 10.1016/S0761-8425(06)71812-5. [DOI] [PubMed] [Google Scholar]
- 20.Pizzo AM, Chellini E, Grazzini G, Cardone A, Badellino F. Italian general practitioners and smoking cessation strategies. Tumori. 2003;89(3):250–54. doi: 10.1177/030089160308900303. [DOI] [PubMed] [Google Scholar]
- 21.Nardini S, Bertoletti R, Rastelli V, Donner CF. The influence of personal tobacco smoking on the clinical practice of Italian chest physicians. Eur Respir J. 1998;12(6):1450–53. doi: 10.1183/09031936.98.12061450. [DOI] [PubMed] [Google Scholar]
- 22.Kawahara K, Ohida T, Osaki Y, Mochizuki Y, Minowa M, Yamaguchi N, Kusaka Y. Study of the smoking behavior of medical doctors in Fukui, Japan and their antismoking measures. J Epidemiol. 2000;10(3):157–62. doi: 10.2188/jea.10.157. [DOI] [PubMed] [Google Scholar]
- 23.Pärna K, Rahu K, Barengo NC, Rahu M, Sandström PH, Jormanainen VJ, Myllykangas MT. Comparison of knowledge, attitudes and behaviour regarding smoking among Estonian and Finnish physicians. Soz Praventivmed. 2005;50(6):378–88. doi: 10.1007/s00038-005-4089-z. [DOI] [PubMed] [Google Scholar]
- 24.Pipe A, Sorensen A, Reid R. Physician smoking status, attitudes towards smoking, and cessation advice to patients: An international survey. Patient Educ Couns. 2009;74(1):118–23. doi: 10.1016/j.pec.2008.07.042. [DOI] [PubMed] [Google Scholar]
- 25.Smith DR, Leggat PA. An international review of tobacco smoking in the medical profession: 1974–2004. BMC Public Health. 2007;7:115. doi: 10.1186/1471-2458-7-115. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Kapur A. Smoking among Physicians in Canada. 2009. [Google Scholar]
- 27.Sloan JF, Aaronson N, Cappelleri JC, Fairclough DL, Varricchio C, the Clinical Significance Consensus Meeting Group Assessing the clinical significance of single items relative to summated scores. Mayo Clinic Proc. 2002;77(5):479–87. doi: 10.1016/S0025-6196(11)62218-0. [DOI] [PubMed] [Google Scholar]
- 28.Gardner DG, Cummings LL. Single-item versus multiple-item measurement scales: An empirical comparison. Educ Psycholog Measurement. 1998;58(6):898–915. doi: 10.1177/0013164498058006003. [DOI] [Google Scholar]