Training family practice and internal medicine residents to counsel patients who smoke: improvement and retention of counseling skills.

This investigation builds on an earlier study by describing the final results of a training program that teaches internal medicine and family practice residents to counsel patients to stop smoking. In this study, 198 residents participated in a three-hour training program which included small group discussion and role-playing exercises. Videotaped observations of role-playing performances were used to assess behavioral outcomes related to counseling skills for 104 residents who completed pre-, immediate post-, and long-term follow-up testing. The present findings support previous results that show the training program has a significant positive effect on physician smoking cessation counseling skills. A subsample of residents continued to exhibit improved counseling skills one year after the initial educational interventions, suggesting that these skills can be retained over time.

Increasing the efficacy of physician-delivered smoking interventions: a randomized clinical trial.

OBJECTIVE: To assess the relative impacts of three physician-delivered smoking interventions in combination with follow-up contact from behavioral counselors. DESIGN: Randomized controlled trial with pre- post measures of smoking rates. This paper reports six-month outcome data. SETTING: Participants were recruited from among patients seen by 196 medical and family practice residents in five primary care clinics. PARTICIPANTS: Participants were 1,286 patients out of 1,946 eligible smokers approached. The patient group was 57% female and 91% white, had an average age of 35 years, and smoked, on average, slightly over one pack per day. INTERVENTION: Physicians were trained to provide each of three interventions: advice only, brief patient-centered counseling, and counseling plus prescription of nicotine-containing gum (Nicorette). Half the patients received follow-up in the form of telephone counseling at three-monthly intervals from behavioral counselors. MEASUREMENTS AND MAIN RESULTS: Changes in smoking behaviors were assessed by telephone interview six months after physician intervention. The differences in one-week point prevalence cessation rates among the physician interventions were significant (p less than 0.01): advice only, 9.1%; counseling, 11.9%; counseling plus gum, 17.4%; with no effect for telephone counseling. The time elapsed from physician encounter to initial quitting and the length of that period of abstinence also showed significant benefit of the counseling interventions. Patients receiving physician counseling were much more likely than those not receiving counseling to rate their physician as very helpful (p less than 0.001). Multiple regression analyses are also reported. CONCLUSION: Smoking intervention counseling provided by physicians is well received by patients and significantly increases the likelihood of cessation at six months, an effect that is augmented by the prescription of nicotine-containing gum, when compared with physician-delivered advice. Follow-up telephone counseling does not contribute significantly to smoking behavior changes.

Families and intensive care nurses: comparison of perceptions.

This study compared family members' and nurses' perceptions on families' needs when a relative was hospitalized in an intensive care unit (ICU). Family members (N = 32) and nurses (N = 23) complete equivalent 44-item questionnaires. Both family members and nurses agreed that the greatest needs of families were anxious at admission (P less than 0.05). Families and nurses seemed satisfied in the Participation/Information and Emotional Support categories, but more disagreements were noted in these areas. More nurses perceived families as not wanting to participate in patient care (P less than 0.003), felt that families did not have enough time to visit (P less than 0.004), believed that families were comfortable expressing their feelings (P less than 0.02) but thought families were uncomfortable asking questions (P less than 0.01). It was concluded that families be prepared for the patient's condition and appearance, and for the hospital milieu in order to cope more effectively with excessive stress in time of crisis. Concordance in perceived needs of family members and care providers may lead to greater need satisfaction and it is advocated that both the patient and the family (rather than the patient alone) be the focus of treatment because of the relationship between social support and patient recovery.

Potential consumer participation in a boycott of tobacco-company-owned nontobacco products.

A random telephone survey was conducted to measure the public's willingness to participate in a boycott of popular consumer products manufactured by corporations owned by tobacco companies. Results suggest a strong interest in such a boycott. Previous boycott experiences, attitudes, and smoking statuses significantly predicted subjects' willingness to participate. Age was inversely related to willingness to participate, while sex, income, ethnicity, and education were not related to this variable.