title: Orthopaedic trauma patients and smoking: Knowledge deficits and interest in quitting.
abstract: BACKGROUND
  Smoking is associated with increased complications in fracture care. Smoking cessation has a positive impact on outcomes. It is unknown whether orthopaedic trauma patients understand the ill effects of smoking on fracture care and whether knowledge can improve cessation interest. We hypothesized that (1) smokers less fully understand the negative effects of smoking than do nonsmokers, (2) an increased proportion of orthopaedic trauma patients are further in the process of change to quit smoking, (3) increased knowledge predicts increased readiness to quit, and (4) minimal education through a survey can improve interest in smoking cessation.
  
  
  METHODS
  Single-centre cross-sectional cohort survey study. Patients were approached consecutively for participation. Patients 18 years or older with a new fracture in our clinic for follow-up were eligible. Smokers and nonsmokers were included and surveyed regarding demographics. Smokers were asked questions about fractures and general knowledge questions regarding the effects of smoking on health. Smokers' interest in smoking cessation was assessed with direct questions, and transtheoretical model stage of change was queried before and after survey administration.
  
  
  RESULTS
  One hundred twelve patients participated (44 smokers, 68 nonsmokers; 75 male patients, 37 female patients). Forty-eight percent of smokers stated that the fracture made them more likely to quit. Smokers answered more questions incorrectly than did nonsmokers (p=0.003). An increased percentage of smokers were in favourable stages of change compared with a population-based tobacco survey (68% versus 54%, p=0.008). Survey administration increased interest in quitting in 48%, and 11% modified their stage of change towards quitting. Smokers scoring higher on knowledge questions had more than 2-fold increased odds of being in a favourable stage of change (p=0.013; odds ratio, 2.13; 95% confidence interval, 1.744-3.855).
  
  
  CONCLUSIONS
  Compared with nonsmokers, smokers less fully understand the negative effects of smoking on fracture care and general health. A large proportion of orthopaedic trauma patients who smoke are interested in smoking cessation and are possibly further along the pathway to change than expected. Brief education through a survey can increase interest in quitting. Formal education intervention may improve cessation rates and fracture outcomes.
authors.affiliation: Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD 21201, USA. Electronic address: pmatuszewski@umoa.umm.edu.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Matuszewski
authors.affiliation: Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
authors.forename: Christina L
authors.initials: CL
authors.lastname: Boulton
authors.affiliation: Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
authors.forename: Robert V
authors.initials: RV
authors.lastname: O'Toole
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D017102:Fracture Healing; D050723:Fractures, Bone / Q000503:physiopathology* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D008962:Models, Theoretical; D009042:Motivation; D010353:Patient Education as Topic; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects* / Q000503:physiopathology / Q000523:psychology; D016540:Smoking Cessation / Q000523:psychology* / Q000706:statistics & numerical data
keywords: Fracture care; Smoking cessation; Transtheoretical model