title: Talking about smoking in primary care medical practice--results of experimental studies from the US, UK and Germany.
abstract: OBJECTIVE
  To analyse effects of patient and physician characteristics on questions and advice about smoking in primary care practice and to examine country differences.
  
  
  METHODS
  We conducted a factorial experiment, employing filmed scenarios in which actors played the role of patients with symptoms of coronary heart disease (CHD) or type 2 diabetes. Versions were filmed with patient-actors of different gender, age, race, and socioeconomic status. The videotapes were presented to primary care physicians in the US, UK and Germany. Physicians were asked whether they would ask questions about smoking or give cessation advice.
  
  
  RESULTS
  Female and older CHD patients are less likely to be asked or get advice about smoking in all three countries. Effects of physician attributes are weak and inconsistent. Compared to physicians in the US and the UK, German doctors are least likely to ask questions or give advice.
  
  
  CONCLUSIONS
  Although all physicians viewed the same cases their questioning and advice giving differed according to patient attributes and country. Due to the experimental design external validity of the study may be limited.
  
  
  CONCLUSIONS
  Findings have implications for medical education and professional training of physicians as well as for the organization and financing of health care.
authors.affiliation: Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Germany. o.knesebeck@uke.de
authors.forename: Olaf
authors.initials: O
authors.lastname: von dem Knesebeck
authors.forename: Anke
authors.initials: A
authors.lastname: Hoehne
authors.forename: Carol
authors.initials: C
authors.lastname: Link
authors.forename: Lisa
authors.initials: L
authors.lastname: Marceau
authors.forename: Ann
authors.initials: A
authors.lastname: Adams
authors.forename: Martin
authors.initials: M
authors.lastname: Roland
authors.forename: Stephen
authors.initials: S
authors.lastname: Campbell
authors.forename: Johannes
authors.initials: J
authors.lastname: Siegrist
authors.forename: John
authors.initials: J
authors.lastname: McKinlay
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001291:Attitude of Health Personnel; D003142:Communication; D003327:Coronary Disease / Q000175:diagnosis; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis; D005163:Factor Analysis, Statistical; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D016544:Patient Simulation; D010817:Physician-Patient Relations; D010820:Physicians; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D012737:Sex Factors; D016540:Smoking Cessation; D000074606:Smoking Prevention; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D006113:United Kingdom; D014481:United States; D014743:Videotape Recording; D055815:Young Adult