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Smoking status as a vital sign

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Abstract

OBJECTIVE: We conducted this study to determine if a smoking status stamp would prompt physicians to increase the number of times they ask, advise, assist, and arrange follow-up for African-American patients about smoking-related issues.

DESIGN: An intervention study with a posttest assessment (after the physician visit) conducted over four 1-month blocks. The control period was the first 2 weeks of each month, while the following 2 weeks served as the intervention period.

SETTING: An adult walk-in clinic in a large inner-city hospital.

PARTICIPANTS: We consecutively enrolled into the study 2,595 African-American patients (1,229 intervention and 1,366 control subjects) seen by a housestaff physician.

INTERVENTIONS: A smoking status stamp placed on clinic charts during the intervention period.

MAIN RESULTS: Forty-five housestaff rotated through the clinic in 1-month blocks. In univariate analyses, patients were significantly more likely to be asked by their physicians if they smoke cigarettes during the intervention compared with the control period, 78.4% versus 45.6% (odds ratio [OR] 4.28; 95% confidence interval [CI] 3.58, 5.10). Patients were also more likely to be told by their physician to quit, 39.9% versus 26.9% (OR 1.81; 95% CI 1.36, 2.40), and have follow-up arranged, 12.3% versus 6.2% (OR 2.16; 95% CI 1.30, 3.38).

CONCLUSIONS: The stamp had a significant effect on increasing rates of asking about cigarette smoking, telling patients to quit, and arranging follow-up for smoking cessation. However, the stamp did not improve the low rate at which physicians offered patients specific advice on how to quit or in setting a quit date.

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Preliminary data were presented as an oral abstract at the national Society of General Internal Medicine meeting, Washington, DC, May 1, 1996.

Funding sources for the project included the American Lung Association National Research Grant, the Cancer Research Foundation of America, the National Cancer Institute (RO1CA77856), and a Robert Wood Johnson Foundation Generalist Faculty Award to Dr. Ahluwalia (032586).

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Ahluwalia, J.S., Gibson, C.A., Kenney, R.E. et al. Smoking status as a vital sign. J GEN INTERN MED 14, 402–408 (1999). https://doi.org/10.1046/j.1525-1497.1999.09078.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.1999.09078.x

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