title: Impact and Duration of Brief Surgeon-Delivered Smoking Cessation Advice on Attitudes Regarding Nicotine Dependence and Tobacco Harms for Patients with Peripheral Arterial Disease.
abstract: BACKGROUND
  Despite the recognized benefits of smoking cessation, many clinicians question if a brief smoking cessation intervention can help dedicated smokers with peripheral arterial disease understand nicotine dependence and harms related to smoking. We investigated the impact and durability of a multimodal smoking cessation intervention on patient attitudes regarding nicotine dependence and the health effects of smoking.
  
  
  METHODS
  We conducted a pilot cluster-randomized trial of a brief smoking cessation intervention at 8 vascular surgery practices between September 1, 2014 and August 31, 2015. Compared with control sites, patients at intervention sites received protocolized brief cessation counseling, medications, and referrals to a quitline. After their clinic visit and again at 3 months, participants completed a brief survey about patient attitudes regarding nicotine dependence and the health effects of smoking. Responses to questions were analyzed using chi-squared test and Student's t-test.
  
  
  RESULTS
  All trial participants (n = 156) complete the initial survey, and 75 (45%) participants completed the follow-up survey. Intervention and control patients both reported a greater than 30-pack-year history (80% vs. 90%, P = 0.07) and previous failed quit attempts (77% vs. 78%, P = 0.8). Compared with usual care, patients in the intervention group were more likely to describe hearing advice to quit from their surgeon (98% vs. 77%, P < 0.001), and expressed "a lot" or "some" interest in quitting (95.4% vs. 85.7%, P = 0.05). Patients in the intervention group were also more likely to acknowledge their addictive behaviors, consistently scoring higher on question bank items regarding nicotine addiction (52.9 vs. 48.0, P = 0.006) and the negative health effects of smoking (scaled score 56.6 vs. 50.6, P = 0.001). When resurveyed 3 months after intervention, patients in the intervention group had larger declines in nicotine dependence and health effect domains, suggesting durable impact of the intervention on patient attitudes regarding nicotine addiction and smoking harms.
  
  
  CONCLUSIONS
  Brief smoking cessation counseling by a vascular surgeon increases patient interest in smoking cessation and awareness of smoking harms, and this effect was durable 3 months after intervention. This evidence suggests that even brief counseling within a surgical clinic has the potential to impact patient desire to quit.
authors: Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH; VA Outcomes Group, White River Junction, VT. Electronic address: Karina.A.Newhall@hitchcock.org.
authors: Karina
authors: K
authors: Newhall
authors: Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.
authors: Bjoern
authors: B
authors: Suckow
authors: Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.
authors: Emily
authors: E
authors: Spangler
authors: Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
authors: Benjamin S
authors: BS
authors: Brooke
authors: University of Massachusetts Medical School, Worcester, MA.
authors: Andres
authors: A
authors: Schanzer
authors: Department of Vascular Surgery, Louisiana State University Medical Center, Shreveport, LA.
authors: Tze-Woei
authors: TW
authors: Tan
authors: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH.
authors: Mary
authors: M
authors: Burnette
authors: RAND Corporation, Boston, MA.
authors: Maria Orlando
authors: MO
authors: Edelen
authors: Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston, MA.
authors: Alik
authors: A
authors: Farber
authors: VA Outcomes Group, White River Junction, VT; Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.
authors: Philip
authors: P
authors: Goodney
mesh_terms: D000368:Aged; D001364:Awareness; D016009:Chi-Square Distribution; D003376:Counseling; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010349:Patient Compliance; D010353:Patient Education as Topic; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D010819:Physician's Role; D010865:Pilot Projects; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000009:adverse effects / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D000074606:Smoking Prevention; D066231:Surgeons; D011795:Surveys and Questionnaires; D013997:Time Factors; D014029:Tobacco Use Disorder / Q000150:complications / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States