A survey of physicians' views and practices on patient education for smoking cessation

Minority women and tobacco: implications for smoking cessation interventions

Quitting smoking is the single most important preventive health behavior a woman can perform to significantly reduce her chances of morbidity and premature mortality. Minority women are an extremely important population to target for smoking cessation intervention. Rates and risk factors for cardiovascular diseases and cancer are markedly higher among women of certain minority groups. In addition, smoking prevalence rates in women of some ethnic groups are elevated relative to the majority population of women, and specific groups have displayed slower rates of decline in smoking. Furthermore, minority women tend to have less access and appear to be less responsive to smoking cessation programs aimed at the majority culture. Thus, consideration of the practical and cultural needs of ethnic minority women is imperative when designing smoking intervention programs. This article describes the smoking behaviors of African-American, American Indian and Native Alaskan, Asian and Pacific Islander, and Hispanic women smokers, in order to gain a greater understanding of the treatment needs of these women. Information on prevalence rates and smoking patterns, barriers to quitting, and findings from intervention studies within each population are reviewed as well as recommendations for smoking cessation treatment.

Screening for adolescent smoking among primary care physicians in California

OBJECTIVES

This study determined how often primary care physicians ask adolescents about smoking.

METHODS

We surveyed a stratified random sample of community-based, board-certified California physicians, using a mailed questionnaire.

RESULTS

Overall, physicians (n = 343; 77% response rate) screened younger adolescents for regular smoking during 71.4% (95% confidence interval [CI] = 67.9, 74.9) of routine physical exams and older adolescents during 84.8% (95% CI = 82.3, 87.4) of such visits. For acute-care visits, the screening rates were 24.4% (95% CI = 20.6, 28.1) for younger and 40.2% (95% CI = 36.4, 44.0) for older adolescents. Physicians asked 18.2% (95% CI = 15.2, 21.3) of younger and 35.6% (95% CI = 32.0, 39.1) of older adolescents about experimental smoking. Screening varied by specialty.

CONCLUSIONS

These data imply that physicians are missing opportunities to screen adolescents for smoking.

Increasing response rates in physicians' mail surveys: an experimental study

It is becoming increasingly difficult to obtain high response rates in physicians' mail surveys. In 1983-84, we tested the effectiveness of two techniques among 604 Quebec physicians who had not responded to an initial letter. A handwritten thank you note at the bottom of the letter accompanying the questionnaire and a more personalized mailout package increased response rates by 40.7 per cent and 53.1 per cent, respectively, compared to control groups.

Physicians' perceptions of their role in cardiovascular risk reduction

Fifty randomly selected family physicians were interviewed to evaluate the role of primary care physicians in the reduction and control of cardiovascular risk in their patients. The interview schedule, developed from the PRECEDE framework, incorporated three categories of factors modifying behavior: predisposing, reinforcing, and enabling. In relation to high blood pressure, elevated serum cholesterol, and smoking, physicians were questioned regarding (a) knowledge and beliefs of desirable practice, (b) perceptions of personal ability, (c) factors that affect their preventive performance, and (d) perceptions of their own role and those of other resources. Physicians believed all three risk factors to be modifiable, and that reduced cardiovascular risk could prolong life and improve quality of life. Participants perceived themselves most effective in reducing high blood pressure, followed by serum cholesterol reduction and smoking cessation. Relationships with patients, patient compliance, personal committment, and belief in the efficacy of risk reduction were most frequently perceived to contribute to effectiveness. Physicians perceived themselves least skilled in enhancing patient compliance and achieving behavior change. Most physicians were committed to cardiovascular disease prevention and saw their own role as central. Contributions of other resources were not well understood. The effect of these complex and interacting perceptions has implications for attempts to enhance physicians' preventive activities.