Evaluation of a direct mailing campaign to increase physician awareness and utilization of a quitline fax referral service.

Research has shown that fax referral services play an important role in linking people who are ready to quit tobacco use with effective cessation support provided through telephone-based quitlines. While many states have implemented fax referral services to assist health care providers in connecting their patients to quitlines, few published studies delineate optimum ways to promote this service to providers, particularly the role of direct mail educational campaigns. This is one of the first studies to evaluate the effectiveness of a small-scale educational and promotional campaign designed to increase health care providers' awareness and utilization of a state tobacco cessation quitline fax referral service. The campaign included a direct mailing to 6,197 health care providers in North Carolina. The mailing consisted of a large tube, in the shape of cigarette, with enclosed fax referral promotional materials. An 8-month follow-up survey was mailed to a 10% random sample of family physicians, pediatricians, dentists, and orthodontists who were sent the promotional tube mailing. Valid surveys were returned by 271 providers (response rate = 46%). Forty-four percent of respondents remembered receiving the tube mailing, and 40% reported familiarity with the fax referral service. While only 3.5% of respondents reported referring a patient to the quitline using the fax referral service in the previous 6 months, almost one-third reported an intention to use the fax referral service in the future. The pilot promotional campaign increased awareness of the fax referral service more than service utilization. While increased utilization of the service by health care providers appears promising, additional research is needed on how to maximize educational and promotional campaigns that influence clinician fax referral behaviors. The results of this study can help guide the development of future fax referral promotional campaigns to increase clinician access to and utilization of state quitlines.

Influence of a tobacco-free hospital campus policy on smoking status of hospital employees.

PURPOSE: To examine the influence of a tobacco-free hospital campus (TFHC) policy on employee smoking behavior. DESIGN: Questionnaires immediately prior to, 6 months after, and 1 year after implementation of a TFHC policy. SETTING: University-affiliated hospital system. SUBJECTS: A cohort of smokers and recent quitters. MEASURES: Smoking status, quit attempts, influence of TFHC policy. ANALYSIS: Descriptive. RESULTS: From 2024 employees who responded to an initial online survey prior to implementation of a TFHC policy, 307 respondents reported either current smoking or quitting smoking within the past 6 months. Of these, 210 (68%) agreed to follow-up surveys at 6 and 12 months post-policy implementation. At each of the three times, between 15% and 18.5% of the cohort reported not smoking, with at least 48% of those not smoking reporting 6 to 12 months continuous abstinence. Sixty percent or more of those who reported quit attempts or not smoking indicated that the TFHC policy was influential in their efforts. CONCLUSIONS: A TFHC policy may lead to increased employee smoking quit attempts and successful cessation. Health care facilities should broaden smoking restrictions to include the entire workplace campus, not only to reduce exposure to environmental tobacco smoke, but also to increase tobacco cessation.

Statewide diffusion of 100% tobacco-free college and university policies.

OBJECTIVES: As smoking among college students reached new highs in the 1990s, most interventions for college student smoking prevention focused on individual student knowledge, attitudes and beliefs. No published studies report on statewide movements to accelerate the adoption of tobacco-free policies on college campuses. The results of the first 4 years of the North Carolina Tobacco-Free Colleges Initiative are presented. METHODS: The North Carolina Health and Wellness Trust Fund developed a multilevel intervention to accelerate the diffusion of tobacco-free policies on college campuses, including funding campus coordinators and coalitions to tailor activities to the campus environment at 64 colleges. Evaluators tracked process and policy outcomes as well as the diffusion of policy adoption from January 2006-December 2009. RESULTS: Prior to the initiative, only one small, private college campus in North Carolina was tobacco-free. By 4 years into the initiative, 33 colleges and community colleges, representing more than 159 300 students, have adopted comprehensive tobacco-free policies to protect students, faculty, staff and visitors. Participating campuses also adopted 68 policies restricting smoking in certain areas and limiting industry activity. CONCLUSIONS: Tobacco-free policy adoption on college campuses can be accelerated with a multilevel statewide intervention.

Secondhand smoke policies at state and county fairs.

OBJECTIVES: We sought to assess the smoking policies at state and county fairs in North Carolina. METHODS: We contacted North Carolina fair managers by telephone to solicit participation in a survey that assessed the extent to which fairs have written policies about smoking and secondhand smoke (SHS) exposure, managers' beliefs concerning the health risks associated with SHS exposure, and specific reasons that might prompt managers to adopt smoke-free policies. RESULTS: Attempts were made to contact 47 fair managers, and 37 (66.0%) participated in the study. We found that although almost two-thirds of fairs prohibited smoking indoors, the vast majority (83.9%) had no limits on outdoor smoking. Most fair managers (84.6%) acknowledged that SHS may cause lung cancer, and a majority (51.6%) reported a belief that their patrons would largely be supportive of a more restrictive policy. LIMITATIONS: Fair managers' responses were primarily based on their own opinions, estimates, and attitudes. CONCLUSIONS: Because of the high number and density of fair patrons, unrestricted outdoor smoking likely exposes most patrons to SHS. Action to eliminate all exposure to SHS at state and county fairs is needed.

Smoking as a vital sign: prompts to ask and assess increase cessation counseling.

BACKGROUND: Strategies to improve smoking cessation counseling in clinical settings are critical to supporting smokers' attempts to quit. This study evaluates the impact of adding 2 smoking-related vital sign questions in an electronic medical records system on identification, assessment, and counseling for patients who smoke: "Current smoker?" and "Plan to quit?" METHODS: Baseline data and data after intervention were collected through record review of 899 randomly selected patient visits across 3 outpatient clinics. RESULTS: From before to after intervention, identification of smokers increased 18% (from 71% to 84%; P<.001), and assessment for a plan to quit increased 100% (from 25.5% to 51%; P<.005). Among all smokers, cessation counseling increased 26% (from 23.6% to 29.8%; P=.41). Significantly more smokers who received the assessment for a plan to quit received cessation counseling (46% vs. 14%, P<.001). Regression analysis showed that patients receiving an assessment for plan to quit were 80% more likely to receive cessation counseling (OR 0.209; 95% CI, 0.095-0.456). CONCLUSIONS: Physician-documented counseling rates are significantly higher when patients are asked about smoking and assessed for a plan to quit. Two questions that ask about smoking status and assess plans to quit may provide prompts to increase the likelihood that patients who smoke receive cessation counseling.

State adoption of 100% smoke-free acute non federal hospital campus policies.

To assess the number and percentage of acute care hospitals in the U.S. that have adopted smoke-free hospital campus (SFHC) policies, researchers conducted an assessment from January 2008 to May 2008 of available data on SFHC policy adoption in each state. Slightly more than one third (34.4%) of acute care, non-Federal hospitals had adopted such policies, with wide variation of policy adoption between states.