Effects of physician counseling on the smoking behavior of asbestos-exposed workers

doi:10.1016/0091-7435(84)90015-X

Preventive Medicine

Volume 13, Issue 5, September 1984, Pages 462-476

https://doi.org/10.1016/0091-7435(84)90015-X Get rights and content

Abstract

Physician antismoking advice has been shown to increase smoking cessation, particularly among patients who have medical problems or perceive themselves to be at risk. The present study tested three hypotheses: (a) providing 3 to 5 min of behavioral counseling regarding a cessation strategy would be more effective than simply warning the smoker to quit smoking; (b) smokers with abnormal pulmonary function would be more likely to comply with medical advice than would smokers with normal pulmonary function; and (c) that smokers with abnormal pulmonary function who receive behavioral counseling would be the group most likely to achieve prolonged abstinence. Asbestos-exposed smoking men undergoing screening in a mandated program for naval shipyard workers were categorized as having normal or abnormal pulmonary status on the basis of chest X ray and pulmonary function tests (PFT). They were then randomly assigned within PFT categories to receive either a simple warning or 3 to 5 min of behavioral cessation counseling from the physician who gave them the results of their pulmonary tests. Subjects' smoking status was evaluated at 3- and 11-month intervals following the physician intervention. Smokers who received behavioral counseling were more likely to quit and remain abstinent over the 11-month period (8.4% abstinent) than were smokers given a minimal warning (3.6% abstinent). Prolonged abstinence rates among abnormal PFT subjects (3.7%) did not differ from those of normals (5.9%). The group with normal PFT who received behavioral counseling achieved the highest level of abstinence (9.5%). Maintaining adequate physician compliance with the counseling protocol proved difficult; implications of this for future efforts are discussed.

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In a similar fashion, another study [18] found significant increases in abstinence at 12- and 24-months among males randomized to a stage-based self-help manual as compared to those receiving no self-help manuals. With regards to the five studies employing multi-component interventions, two studies employed the use of behavioral counseling and SC pamphlets [22] and relapse prevention in conjunction with a contingency contract [15]. These studies both found significant increases in end-of-treatment abstinence in the intervention relative to the control group.
: Smoking is associated with adverse health effects and significant disease burden among men, making it an important men's health issue. Conversely, smoking cessation is associated with significant reductions in smoking-attributable risk. However, few studies have examined men-specific smoking cessation programs. The aim of our study was to conduct a comprehensive review of the literature to identify men-specific smoking cessation programs to make recommendations about future efforts to develop, implement and evaluate men-centered smoking cessation interventions.
: A comprehensive search of the COCHRANE Library, MEDLINE, and PsycINFO and SIGLE databases was performed. Out of 873 studies that we retrieved from the data base search, 11 publications met our inclusion criteria.
: Of the 11 studies in our review, 7 employed a randomized controlled trial (RCT) design, 3 employed a cohort design, and 1 article employed a two-group pretest–posttest design. Only two studies had treatments that were tailored specifically for men. Overall, the majority of RCTs (6/7) provided significant treatment effects in favor of the intervention group.
: The few descriptive studies that have examined smoking cessation outcomes in men-only programs support calls for men-centered interventions. However, the factors underpinning men's smoking and cessation require further research attention. Future studies are needed that examine, incorporate, and evaluate sex-and gender-specific factors related to smoking cessation outcomes among men. Such studies will improve men's health by enhancing our understanding of their smoking behaviors. Moreover, the findings derived from such studies will be useful in guiding the development of tailored approaches to men's smoking cessation.
Improved smoking cessation in smokers given ultrasound photographs of their own atherosclerotic plaques
2002, Preventive Medicine
Background. We examined whether making smokers aware that they had developed peripheral atherosclerosis would improve smoking cessation.
Methods. Smokers selected from the general population were randomly allocated to undergo high-resolution B-mode ultrasonography of their carotid and femoral arteries. All smokers received quit-smoking counseling. Smokers with ≥1 atherosclerotic plaque were given two photographs of a plaque with a relevant explanation. Quit rates were assessed by telephone 6 months later.
Results. Seventy-nine smokers did not undergo ultrasonography (A). Among the 74 smokers submitted to ultrasonography, 20 had no plaque (B) and 54 had ≥1 plaque (C). Quit rates were, respectively, 6.3, 5.0, and 22.2% in groups A, B, and C. Quit rates were higher in smokers submitted to ultrasonography (B + C vs A; P = 0.031) and in those receiving photographs (C vs A + B; P = 0.003). Smoking cessation was independently associated with intervention C (OR = 6.2; 95% CI = 1.8–21) and a white-collar job but not with age or gender.
Conclusions. Providing smokers with photographs demonstrating atherosclerosis on their own person was an effective adjunct to physician's advice to quit smoking. Since ultrasonography is used increasingly often in clinical practice for cardiovascular risk stratification, this can provide an additional opportunity and means to deter smokers from smoking.
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2001, Chest
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The findings have decisive practical implications in these patients for the treatment of smoking, which is essential and should range from medical advice to more intensive interventions.30 Different studies313233 have shown that smokers with abnormal spirometric results are less likely than other smokers to quit over the next year. Abnormal spirometry results may identify the heaviest smoker or the more addicted smoker who is less likely to quit.34
To ascertain the differences in smoking characteristics between a group of smokers with COPD and another group of healthy smokers, both of which were identified in a population-based epidemiologic study.
This is an epidemiologic, multicenter, population-based study conducted in seven areas of Spain. A total of 4,035 individuals, men and women aged 40 to 69 years, who were selected randomly from a target population of 236,412 subjects, participated in the study.
Eligible subjects answered the European Commission for Steel and Coal questionnaire. Spirometry was performed followed by a bronchodilator test when bronchial obstruction was present. The Fagerström questionnaire was used for study of the degree of physical nicotine dependence, and the Prochazka model was followed for analysis of the smoking cessation phase.
Of 1,023 active smokers, 153 (15%) met the criteria for COPD. Smokers with COPD were more frequently men (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.21 to 3.95), were ≥ 46 years of age (OR, 1.97; 95% CI, 1.18 to 3.31), had a lower educational level (OR, 1.96; 95% CI, 1.23 to 3.14), and had smoked> 30 pack-years (OR, 3.70; 95% CI, 2.42 to 5.65). Smokers with COPD showed a higher dependence on nicotine than healthy smokers (mean[± SD] Fagerström test score, 4.77 ± 2.45 vs 3.15 ± 2.38, respectively; p < 0.001) and higher concentrations of CO in exhaled air (mean concentration, 19.7 ± 16.3 vs 15.4 ± 12.1 ppm, respectively; p < 0.0001). Thirty-four percent of smokers with COPD and 38.5% of smokers without COPD had never tried to stop smoking.
Smokers with COPD have higher tobacco consumption, higher dependence on nicotine, and higher concentrations of CO in exhaled air, suggesting a different pattern of cigarette smoking. Cases of COPD among smokers predominate in men and in individuals with lower educational levels. A significant proportion of smokers have never tried to stop smoking; thus, advice on cessation should be reinforced in both groups of smokers.
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1999, Journal of Clinical Epidemiology
We studied the relationship between smokers’ sociodemographic characteristics, their smoking habit, health status, and the probability of their having been approached for recruitment in the smoking cessation trial performed in Turin, Italy, with the aim of gathering information on the role of selection criteria adopted by general practitioners (GPs) in offering anti-smoking counseling. The 965 smokers who were offered participation in the trial were matched to a sample of eligible smokers (n = 277), selected from the rosters of the 42 GPs collaborating in the trial, who had not been invited to participate. The probability of being offered enrollment, estimated through a multiple conditional logistic regression model, assuming the GP as the matching variable, was significantly increased for intermediate (10–19 cigarettes per day: odds ratio [OR] = 4.13; 95% confidence interval [CI]: 2.63–6.47) and heavy (20 cigarettes per day or more: OR = 10.12; 95% CI: 6.51–15.75) smokers, for smokers diagnosed with chronic cardiovascular (OR = 2.06; 95% CI: 1.19–3.58), or respiratory (OR = 2.50; 95% CI: 1.40–4.48) diseases, and for smokers mentioning an intermediate number (2–4) of past quit attempts (OR = 3.70; 95% CI: 2.18–6.28). General Practitioners focused their recruitment activity on higer-risk smokers or smokers who had tried to quit, to offer more clues for intervention. Assessing the potential public health benefit of preventive interventions requires a more systematic evaluation of the generalizability of the reported findings.
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1997, Preventive Medicine
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Results.With the exception of smoking cessation, all interventions for COPD have only been proven effective in symptomatic patients. Two studies found that multifaceted smoking cessation programs that included spirometry were efficacious. There was no effect in a third study that isolated the role of spirometry. Smokers with abnormal spirometric results are less likely than other smokers to quit over the ensuing year.
Conclusions.There is no evidence that spirometry, as an isolated intervention, aids smoking cessation.
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General articleEffects of physician counseling on the smoking behavior of asbestos-exposed workers☆

Abstract

Behav. Ther.

Dis. Chest

Prev. Med.

The impact of providing physicians with quit-smoking materials for smoking patients

Ca.-Cancer J. Clin.

Health United States

Increasing physicians' antismoking influence by applying an inexpensive feedback technique

J. Med. Educ.

Respiratory function tests, normal values at median altitudes and the prediction of normal results

Amer. Rev. Resp. Dis.

General article
Effects of physician counseling on the smoking behavior of asbestos-exposed workers☆