What makes physicians go the extra mile to urge patients to quit tobacco

B11 Physicians’ interest in their patients’ tobacco use has improved significantly. However, given the critical importance of the advice and assistance they give their patients, it is necessary to determine what makes physicians go beyond the basic asking and advising tobacco users and take an active role in preventing or controlling tobacco use. This study was conducted to assess physicians’ clinical practices, level of involvement, and attitudes related to tobacco use. Methods: In the summer of 2003, a 35-question mail survey was fully completed and returned by 834 of 1,750 (52.5%) East Texas physicians. Univariate and multivariate analyses were conducted to explore factors associated with the level of involvement in tobacco use cessation and prevention. Results: More than 50% of respondents reported always asking about smoking; 40% always provided advice; and the vast majority advised when the patient had symptoms (81%) or questions (87%). Only 46% of respondents advised when patients had no symptoms or question and only 26% always prescribed medication for those wanting to quit - and very few referred those patients to a quitting hotline. Receiving training on tobacco issues influenced their attitudes, but did not directly influence their counseling behavior. Doctors with more positive attitudes toward tobacco control (OR=1.88), the self-confidence to deal with tobacco use (OR=3.7), and who also considered preventative advice an integral part of their clinical practice (OR=3.1) were more likely to comprehensively help all smokers. In addition, doctors who reported receiving tobacco related training in medical school or through CME (OR=1.6), and felt better capable of participating in advocacy (OR=14.3) were the most involved in tobacco prevention and control. Conclusions: The general disposition of doctors toward taking part in the elimination of the tobacco epidemic seems to be the strongest factor associated with counseling behavior. Having a strong sense of the importance of prevention and a high confidence in their capacity to do it seems to determine the strongest level of commitment. This study supports the importance of training medical students and physicians to develop positive attitudes and skills for disease prevention and advocacy.