Increasing the efficacy of physician-delivered smoking interventions: a randomized clinical trial.
OBJECTIVE
To assess the relative impacts of three physician-delivered smoking interventions in combination with follow-up contact from behavioral counselors.


METHODS
Randomized controlled trial with pre- post measures of smoking rates. This paper reports six-month outcome data.


METHODS
Participants were recruited from among patients seen by 196 medical and family practice residents in five primary care clinics.


METHODS
Participants were 1,286 patients out of 1,946 eligible smokers approached. The patient group was 57% female and 91% white, had an average age of 35 years, and smoked, on average, slightly over one pack per day.


METHODS
Physicians were trained to provide each of three interventions: advice only, brief patient-centered counseling, and counseling plus prescription of nicotine-containing gum (Nicorette). Half the patients received follow-up in the form of telephone counseling at three-monthly intervals from behavioral counselors.


RESULTS
Changes in smoking behaviors were assessed by telephone interview six months after physician intervention. The differences in one-week point prevalence cessation rates among the physician interventions were significant (p less than 0.01): advice only, 9.1%; counseling, 11.9%; counseling plus gum, 17.4%; with no effect for telephone counseling. The time elapsed from physician encounter to initial quitting and the length of that period of abstinence also showed significant benefit of the counseling interventions. Patients receiving physician counseling were much more likely than those not receiving counseling to rate their physician as very helpful (p less than 0.001). Multiple regression analyses are also reported.


CONCLUSIONS
Smoking intervention counseling provided by physicians is well received by patients and significantly increases the likelihood of cessation at six months, an effect that is augmented by the prescription of nicotine-containing gum, when compared with physician-delivered advice. Follow-up telephone counseling does not contribute significantly to smoking behavior changes.
Ockene
J K
JK
Department of Medicine, University of Massachusetts Medical School, Worcester 01655.
Kristeller
J
J
Goldberg
R
R
Amick
T L
TL
Pekow
P S
PS
Hosmer
D
D
Quirk
M
M
Kalan
K
K
D000328:Adult; D001521:Behavior Therapy; D002638:Chewing Gum; D003376:Counseling; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007396:Internship and Residency; D008297:Male; D009538:Nicotine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010044:Outpatient Clinics, Hospital; D010817:Physician-Patient Relations; D011109:Polymethacrylic Acids / Q000627:therapeutic use*; D011145:Polyvinyls / Q000627:therapeutic use*; D012044:Regression Analysis; D000074606:Smoking Prevention; D013689:Telephone; D061485:Tobacco Use Cessation Devices
D002638:Chewing Gum; D011109:Polymethacrylic Acids; D011145:Polyvinyls; D009538:Nicotine