title: Smoking status as the new vital sign: effect on assessment and intervention in patients who smoke.
abstract: OBJECTIVE
  To assess the effect of expanding the vital signs to include smoking status.
  
  
  METHODS
  We prospectively conducted exit interviews with patients at a general internal medicine clinic in Madison, Wisconsin, during a 16-month period from 1991 to 1993.
  
  
  METHODS
  Patients were surveyed briefly before (N = 870) and after (N = 994) the implementation of a simple institutional change in clinical practice. This change involved training the staff in how to use progress notepaper with a vital sign stamp that included smoking status (current, former, or never) along with the traditional vital signs. Included in the survey were questions about whether the patient smoked, whether the patient was asked that day about smoking status (by a clinician or other staff), and, for smokers, whether they were urged to quit smoking and given specific advice on how to do so.
  
  
  RESULTS
  After expansion of the vital signs, patients were much more likely to report inquiries about their smoking status on the day of a clinic visit (an increase from approximately 58% at baseline to 81% at intervention; P < 0.0001). The vital sign intervention was associated with significant increases in the percentage of smokers who reported that their clinician advised them that day to quit smoking (from approximately 49% at baseline to 70% during the intervention; P < 0.01) and in the percentage who reported that their clinician gave them specific advice that day on how to stop smoking (from approximately 24% at baseline to 43% during the intervention; P < 0.01).
  
  
  CONCLUSIONS
  Expanding the vital signs to include smoking status was associated with a dramatic increase in the rate of identifying patients who smoke and of intervening to encourage and assist with smoking cessation. This simple, low-cost intervention may effectively prompt clinicians to inquire about use of tobacco and offer recommendations to smokers.
authors.affiliation: Center for Tobacco Research and Intervention, University of Wisconsin Medical School, Madison 53706-1532.
authors.forename: M C
authors.initials: MC
authors.lastname: Fiore
authors.forename: D E
authors.initials: DE
authors.lastname: Jorenby
authors.forename: A E
authors.initials: AE
authors.lastname: Schensky
authors.forename: S S
authors.initials: SS
authors.lastname: Smith
authors.forename: R R
authors.initials: RR
authors.lastname: Bauer
authors.forename: T B
authors.initials: TB
authors.lastname: Baker
mesh_terms: D000328:Adult; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011446:Prospective Studies; D012907:Smoking; D016540:Smoking Cessation; D000074606:Smoking Prevention