title: Primary care physician smoking screening and counseling for patients with chronic disease.
abstract: BACKGROUND
  Evidence-based guidelines recommend smoking cessation treatment, including screening and counseling, for all smokers, including those with chronic diseases exacerbated by smoking. Physician treatment improves smoking cessation. Little data describes smoking treatment guideline uptake for patients with chronic cardiopulmonary smoking-sensitive diseases.
  
  
  OBJECTIVE
  Describe U.S. primary care physician (PCP) smoking cessation treatment during patient visits for chronic cardiopulmonary smoking-sensitive diseases.
  
  
  METHODS
  The National (Hospital) Ambulatory Medical Care Survey captured PCP visits. We examined smoking screening and counseling time trends for smokers with chronic diseases. Multivariable logistic regression assessed factors associated with smoking counseling for smokers with chronic smoking-sensitive diseases.
  
  
  RESULTS
  From 2001-2009 smoking screening and counseling for smokers with chronic smoking-sensitive cardiopulmonary diseases were unchanged. Among smokers with chronic smoking-sensitive diseases, 50%-72% received no counseling. Smokers with chronic obstructive pulmonary disease (COPD) (odds ratio (OR)=6.54, 95% confidence interval (CI) 4.85-8.83) and peripheral vascular disease (OR=4.50, 95% CI 1.72-11.75) were more likely to receive smoking counseling at chronic/preventive care visits, compared with patients without smoking-sensitive diseases. Other factors associated with increased smoking counseling included non-private insurance, preventive and longer visits, and an established PCP. Asthma and cardiovascular disease showed no association with counseling.
  
  
  CONCLUSIONS
  Smoking cessation counseling remains infrequent for smokers with chronic smoking-sensitive cardiopulmonary diseases. New strategies are needed to encourage smoking cessation counseling.
authors.affiliation: Department of Pediatrics, University of Utah, 100 Mario Capecchi Drive, Salt Lake City, UT 84113, USA. Electronic address: kevin.nelson@hsc.utah.edu.
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Nelson
authors.affiliation: Department of Pediatrics, University of Utah, 100 Mario Capecchi Drive, Salt Lake City, UT 84113, USA. Electronic address: adam.hersh@hsc.utah.edu.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Hersh
authors.affiliation: Department of Pediatrics, University of Utah, 100 Mario Capecchi Drive, Salt Lake City, UT 84113, USA. Electronic address: flory.nkoy@hsc.utah.edu.
authors.forename: Flory L
authors.initials: FL
authors.lastname: Nkoy
authors.affiliation: Departments of Pediatrics, Epidemiology and Biostatistics, University of California, 3333 California Street, Suite #245, San Francisco, CA 94118, USA. Electronic address: jmaselli@medicine.ucsf.edu.
authors.forename: Judy H
authors.initials: JH
authors.lastname: Maselli
authors.affiliation: Department of Pediatrics, University of Utah, 100 Mario Capecchi Drive, Salt Lake City, UT 84113, USA. Electronic address: raj.srivastava@hsc.utah.edu.
authors.forename: Raj
authors.initials: R
authors.lastname: Srivastava
authors.affiliation: Departments of Pediatrics, Epidemiology and Biostatistics, University of California, 3333 California Street, Suite #245, San Francisco, CA 94118, USA; Philip R. Lee Institute for Health Policy Studies, University of California, 3333 California Street, Suite #265, San Francisco, CA 94118, USA. Electronic address: cabanam@peds.ucsf.edu.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Cabana
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000523:psychology; D003376:Counseling / Q000706:statistics & numerical data*; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D016540:Smoking Cessation / Q000379:methods / Q000706:statistics & numerical data*; D000074606:Smoking Prevention; D014481:United States; D055815:Young Adult
keywords: Cardiovascular disease; Chronic disease; Chronic obstructive pulmonary disease; Guideline; Primary care; Smoking; Tobacco