Original Article
Use of the Vital Sign Stamp as a Systematic Screening Tool to Promote Smoking Cessation

https://doi.org/10.4065/78.6.716Get rights and content

Objectives

To examine the ability of a simple system-wide screening assessment tool, an expanded vital sign stamp, to increase rates of smoker identification, physician advice to quit smoking, and physician assistance in quitting and abstinence rates.

Participants and Methods

This study is a pretest, posttest design in which 5 primary health care clinics were randomly assigned to either the intervention condition, which received the vital sign stamp, or the control condition. Participants (N=9439) were surveyed by using exit interviews at the 5 clinics, both before and after the vital sign intervention was implemented. Participants who were identified as smokers were then contacted 1 year later for follow-up. The study began in February 1995, and all follow-up visits were completed by December 1998.

Results

Implementation of the vital sign stamp significantly increased the rates at which physicians asked participants about their smoking status (17.2% vs 7.5%). However, the rates of physicians advising smokers to quit, assisting them in quitting, and arranging follow-up either stayed constant or decreased. The number of quit attempts and abstinence rates also stayed constant.

Conclusion

A simple system-wide screening assessment tool, while effective in identifying more tobacco users, did not increase the rates at which physicians advised or assisted smokers to quit. Further system-wide changes may be needed to ensure that effective tobacco-dependence treatments are given to smokers.

Section snippets

PARTICIPANTS AND METHODS

Between February 1995 and December 1998, 9439 adults from Dane County, Wisconsin, participated in this study. Participants were approached as they exited 1 of 5 selected health care clinics in Madison. Any adults willing to participate were included. This resulted in a sample of 1611 participants who were current smokers, were older than 18 years, attended only 1 health care clinic, and gave informed consent to participate in the study. General demographic information is provided in Table 1.

RESULTS

To analyze the data regarding physician behavior, we conducted both descriptive and inferential analyses, with patient report serving as the basis for inference regarding physician behavior. For the descriptive analyses, we calculated the proportion of participants who reported that their physician had asked about smoking, advised them to quit, provided assistance in quitting, and arranged follow-up during the baseline and intervention phases. We also used these data to examine rates of quit

DISCUSSION

Although the vital sign stamp did increase the rates at which smokers were identified, it did not appear to promote further tobacco intervention efforts or subsequent successful quitting. Thus, the expanded vital signs changed behavior but only the specific behavior it targeted-asking about smoking. In this study, the vital sign stamp did not increase the rates at which physicians advised smokers to quit, offered assistance in quitting, or arranged follow-up. In fact, the descriptive data

CONCLUSION

The data point to an important although disturbing trend that a simple system-wide intervention is sufficient to change only the behavior it targets. The current intervention targeted asking about smoking, and it effectively increased rates at which participants were asked about their smoking. However, the vital sign stamp intervention was insufficient to instigate treatment of a chronic disease as complex as tobacco dependence. Given that the PHS guideline and other recent studies have shown

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    This study was supported in part by grant HL52081-04 from the National Cancer Institute.

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