Gilpin E A, Pierce J P, Johnson M, Bal D
Center for Population Studies for Cancer Prevention, University of California, San Diego, La Jolla 92093-0901.
J Gen Intern Med. 1993 Oct;8(10):549-53. doi: 10.1007/BF02599637.
To estimate the percentage of California smokers who visit physicians each year and thus determine the extent of the opportunity for physicians to advise their smoking patients to quit; to identify sociodemographic and other characteristics related to smokers' reporting that advice was given; and to look for evidence that physician advice influences quitting behavior.
Data were collected as part of the 1990 California Tobacco Survey, a large (n = 24,296) population-based telephone survey.
9,796 current smokers, including 5,559 daily smokers who had visited a physician in the preceding year.
Two-thirds of all smokers had visited a physician in the year before the interview, but only about 50% of Hispanic and Asian smokers had done so. Multivariate analysis showed that advice at the last visit was independently related to older age, higher cigarette consumption, and poorer perceived health. Compared with smokers never advised to quite by a physician, those advised to quit at the last visit were 1.61 (95% confidence interval, 1.31-1.98) times more likely to report a quit attempt in the preceding year and 1.90 (95% confidence interval, 1.45-2.48) times more likely to be preparing to quit; however, those advised previously but not at the last visit showed no more quitting activity than did smokers never advised to quit.
Physicians have considerable opportunity to reach all demographic subgroups of the population, but the nature of the subgroups advised most (those who are older, have high consumption of cigarettes, or have poor health) suggests that physicians tend to treat such advice as a therapeutic rather than a preventive intervention. Physician advice at the most recent visit encourages patients to think about quitting and probably leads to quit attempts. Thus, it is vital that physicians perform the simple intervention of advising every smoker to quit at every visit.
估算加利福尼亚州每年看医生的吸烟者比例，从而确定医生向吸烟患者提供戒烟建议的机会程度；识别与吸烟者报告已获建议相关的社会人口学及其他特征；并寻找医生建议影响戒烟行为的证据。
数据收集于1990年加利福尼亚州烟草调查，这是一项大规模（n = 24,296）的基于人群的电话调查。
9796名当前吸烟者，其中包括5559名在前一年看过医生的每日吸烟者。
在接受访谈前一年，三分之二的吸烟者看过医生，但只有约50%的西班牙裔和亚裔吸烟者看过医生。多变量分析显示，上次就诊时获得的建议与年龄较大、香烟消费量较高以及自我感觉健康状况较差独立相关。与从未被医生建议戒烟的吸烟者相比，上次就诊时被建议戒烟的吸烟者在前一年报告尝试戒烟的可能性高1.61倍（95%置信区间，1.31 - 1.98），准备戒烟的可能性高1.90倍（95%置信区间，1.45 - 2.48）；然而，之前被建议但上次就诊时未被建议的吸烟者，其戒烟活动并不比从未被建议戒烟的吸烟者更多。
医生有相当多的机会接触到人群中的所有人口亚组，但获得最多建议的亚组（年龄较大、香烟消费量高或健康状况差的人群）的特征表明，医生倾向于将此类建议视为一种治疗而非预防干预措施。最近一次就诊时医生的建议会鼓励患者考虑戒烟，并可能导致尝试戒烟。因此，医生每次就诊时对每位吸烟者进行简单的戒烟建议干预至关重要。
