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Published in: BMC Primary Care 1/2010

Open Access 01-12-2010 | Research article

Missed opportunities for tobacco use screening and brief cessation advice in South African primary health care: a cross-sectional study

Authors: Olufemi B Omole, Kabilabe NW Ngobale, Olalekan A Ayo-Yusuf

Published in: BMC Primary Care | Issue 1/2010

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Abstract

Background

Primary health care (PHC) settings offer opportunities for tobacco use screening and brief cessation advice, but data on such activities in South Africa are limited. The aim of this study was to determine the extent to which participants were screened for and advised against tobacco use during consultations.

Methods

This cross-sectional study involved 500 participants, 18 years and older, attended by doctors or PHC nurses. Using an exit-interview questionnaire, information was obtained on participants' tobacco use status, reason(s) for seeking medical care, whether participants had been screened for and advised about their tobacco use and patients' level of comfort about being asked about and advised to quit tobacco use. Main outcome measures included patients' self-reports on having been screened and advised about tobacco use during their current clinic visit and/or any other visit within the last year. Data analysis included the use of chi-square statistics, t-tests and multiple logistic regression analysis.

Results

Of the 500 participants, 14.9% were current smokers and 12.1% were smokeless tobacco users. Only 12.9% of the participants were screened for tobacco use during their current visit, indicating the vast majority were not screened. Among the 134 tobacco users, 11.9% reported being advised against tobacco use during the current visit and 35.1% during any other visit within the last year. Of the participants not screened, 88% indicated they would be 'very comfortable' with being screened. A pregnancy-related clinic visit was the single most significant predictor for being screened during the current clinic visit (OR = 4.59; 95%CI = 2.13-9.88).

Conclusion

Opportunities for tobacco use screening and brief cessation advice were largely missed by clinicians. Incorporating tobacco use status into the clinical vital signs as is done for pregnant patients during antenatal care visits in South Africa has the potential to improve tobacco use screening rates and subsequent cessation.
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Literature
1.
go back to reference Mitchel BE, Sobel HL, Alexander MH: The adverse health effects of tobacco and tobacco-related products. Prim Care. 1999, 26: 463-498.CrossRef Mitchel BE, Sobel HL, Alexander MH: The adverse health effects of tobacco and tobacco-related products. Prim Care. 1999, 26: 463-498.CrossRef
2.
go back to reference Peer N, Bradshaw D, Laubscher R, Steyn K: Trends in adult tobacco use from two South African demographic and health surveys conducted in 1998 and 2003. S Afr Med J. 2009, 99: 744-749.PubMed Peer N, Bradshaw D, Laubscher R, Steyn K: Trends in adult tobacco use from two South African demographic and health surveys conducted in 1998 and 2003. S Afr Med J. 2009, 99: 744-749.PubMed
3.
go back to reference Pandey A, Patni N, Sarangi S, Singh M, Sharma K, Vellimana AK, Patra S: Association of exclusive smokeless tobacco consumption with hypertension in an adult male rural population of India. Tob Induc Dis. 2009, 5: 15-10.1186/1617-9625-5-15.CrossRefPubMedPubMedCentral Pandey A, Patni N, Sarangi S, Singh M, Sharma K, Vellimana AK, Patra S: Association of exclusive smokeless tobacco consumption with hypertension in an adult male rural population of India. Tob Induc Dis. 2009, 5: 15-10.1186/1617-9625-5-15.CrossRefPubMedPubMedCentral
4.
go back to reference Groenewald P, et al: Estimating the burden of disease attributable to smoking in South Africa in 2000. S Afr Med J. 2007, 674-681. Groenewald P, et al: Estimating the burden of disease attributable to smoking in South Africa in 2000. S Afr Med J. 2007, 674-681.
5.
go back to reference McPhaul M, Punzi HA, Sangy A, Borganelli M, Rude R, Kaplan NM: Snuff-induced hypertension in pheochromocytoma. JAMA. 1984, 252: 2860-2862. 10.1001/jama.252.20.2860.CrossRefPubMed McPhaul M, Punzi HA, Sangy A, Borganelli M, Rude R, Kaplan NM: Snuff-induced hypertension in pheochromocytoma. JAMA. 1984, 252: 2860-2862. 10.1001/jama.252.20.2860.CrossRefPubMed
6.
go back to reference Huhtasaari F, Asplund K, Lundberg V, Stegmayr, Wester PO: Tobacco and myocardial infarction: is snuff less dangerous than cigarettes?. BMJ. 1992, 305: 1252-1256. 10.1136/bmj.305.6864.1252.CrossRefPubMedPubMedCentral Huhtasaari F, Asplund K, Lundberg V, Stegmayr, Wester PO: Tobacco and myocardial infarction: is snuff less dangerous than cigarettes?. BMJ. 1992, 305: 1252-1256. 10.1136/bmj.305.6864.1252.CrossRefPubMedPubMedCentral
7.
go back to reference Eliason M, Lundblad D, Hagg E: Cardiovascular risk factors in young snuff-users and cigarette smokers. J Intern Med. 1991, 230: 17-22. 10.1111/j.1365-2796.1991.tb00401.x.CrossRef Eliason M, Lundblad D, Hagg E: Cardiovascular risk factors in young snuff-users and cigarette smokers. J Intern Med. 1991, 230: 17-22. 10.1111/j.1365-2796.1991.tb00401.x.CrossRef
8.
go back to reference Schroeder KL, Chen MS: Smokeless tobacco and blood pressure. NEJM. 1985, 312: 919-PubMed Schroeder KL, Chen MS: Smokeless tobacco and blood pressure. NEJM. 1985, 312: 919-PubMed
9.
go back to reference Lancaster T, Stead L: Physician advice for tobacco cessation. Cochrane Database Syst rev. 2004, CD000165- Lancaster T, Stead L: Physician advice for tobacco cessation. Cochrane Database Syst rev. 2004, CD000165-
10.
go back to reference Jaen CR, Stange KC, Tumiel LM, Nutting P: Missed opportunities for prevention: smoking cessation counseling and the competing demands of practice. J Fam Pract. 1997, 45: 348-354.PubMed Jaen CR, Stange KC, Tumiel LM, Nutting P: Missed opportunities for prevention: smoking cessation counseling and the competing demands of practice. J Fam Pract. 1997, 45: 348-354.PubMed
11.
go back to reference Easten, Husten C, Malarcher A, Elon L, Caraballo R, Ahluwalia I, Frank E: Smoking cessation counseling by primary care women physicians: Women Physicians' Health Study. Women Health. 2001, 32: 77-91. 10.1300/J013v32n04_05.CrossRef Easten, Husten C, Malarcher A, Elon L, Caraballo R, Ahluwalia I, Frank E: Smoking cessation counseling by primary care women physicians: Women Physicians' Health Study. Women Health. 2001, 32: 77-91. 10.1300/J013v32n04_05.CrossRef
12.
go back to reference Everett K, Odendaal HJ, Steyn K: Doctors' attitudes and practices regarding smoking cessation during pregnancy. S Afr Med J. 2005, 95: 350-354.PubMed Everett K, Odendaal HJ, Steyn K: Doctors' attitudes and practices regarding smoking cessation during pregnancy. S Afr Med J. 2005, 95: 350-354.PubMed
13.
go back to reference Brunnhuber K, Cummings KM, Feit S, Sherman S, Woodcock J: Putting evidence into practice: Smoking cessation. BMJ. 2007, 1-40. Brunnhuber K, Cummings KM, Feit S, Sherman S, Woodcock J: Putting evidence into practice: Smoking cessation. BMJ. 2007, 1-40.
14.
go back to reference Fiore MC, Jaen CR, Baker TB, Bailey WC, Benowitz N, Curry SJ, Dorfman SF, Froelicher ES, Goldstein MG, Healton CG, Henderson PN, Heyman RB, Koh HK, Kottke TE, Lando HA, Mecklenburg RE, Mermelstein RJ, Mullen PD, Orleans CT, Robinson L, Stitzer ML, Tommasello AC, Villejo L, Wewers ME: Treating tobacco use and dependence: 2008 update. US Public health service clinical practice guideline executive summary. Respir Care. 2008, 53: 1217-1222. Fiore MC, Jaen CR, Baker TB, Bailey WC, Benowitz N, Curry SJ, Dorfman SF, Froelicher ES, Goldstein MG, Healton CG, Henderson PN, Heyman RB, Koh HK, Kottke TE, Lando HA, Mecklenburg RE, Mermelstein RJ, Mullen PD, Orleans CT, Robinson L, Stitzer ML, Tommasello AC, Villejo L, Wewers ME: Treating tobacco use and dependence: 2008 update. US Public health service clinical practice guideline executive summary. Respir Care. 2008, 53: 1217-1222.
16.
go back to reference Van Schayck OCP, Pinnock H, Ostrem A, Litt J, Tomlins R, William S, Buffels J, Giannopoulos D, Henrichsen S, Kaper J, Korzh O, Rodriguez AM, Kawaldip S, Zwae N, Yaman H: IPCRG consensus statement: tackling the smoking epidemic-practical guidance for primary care. Prim Care Respir J. 2008, 17: 185-193. 10.3132/pcrj.2008.00060.CrossRefPubMed Van Schayck OCP, Pinnock H, Ostrem A, Litt J, Tomlins R, William S, Buffels J, Giannopoulos D, Henrichsen S, Kaper J, Korzh O, Rodriguez AM, Kawaldip S, Zwae N, Yaman H: IPCRG consensus statement: tackling the smoking epidemic-practical guidance for primary care. Prim Care Respir J. 2008, 17: 185-193. 10.3132/pcrj.2008.00060.CrossRefPubMed
19.
go back to reference Pbert L, Adams A, Quirk M, Hebert JR, OcKene J, Luipolld : The Patient Exit Interview as an assessment of physician-delivered smoking intervention: a validation study. Health Psychol. 1999, 18: 183-188. 10.1037/0278-6133.18.2.183.CrossRefPubMed Pbert L, Adams A, Quirk M, Hebert JR, OcKene J, Luipolld : The Patient Exit Interview as an assessment of physician-delivered smoking intervention: a validation study. Health Psychol. 1999, 18: 183-188. 10.1037/0278-6133.18.2.183.CrossRefPubMed
20.
go back to reference Jiang Y, Ong MK, Tong EK, Yang Y, Nan Y, Gan Q, Hu TW: Chinese physicians and their smoking knowledge, attitudes, and practices. Am J Prev Med. 2007, 33: 15-22. 10.1016/j.amepre.2007.02.037.CrossRefPubMedPubMedCentral Jiang Y, Ong MK, Tong EK, Yang Y, Nan Y, Gan Q, Hu TW: Chinese physicians and their smoking knowledge, attitudes, and practices. Am J Prev Med. 2007, 33: 15-22. 10.1016/j.amepre.2007.02.037.CrossRefPubMedPubMedCentral
21.
go back to reference Zwar N: Smoking cessation. What works?. Aust Fam Physician. 2008, 37: 10-14.PubMed Zwar N: Smoking cessation. What works?. Aust Fam Physician. 2008, 37: 10-14.PubMed
22.
go back to reference Holtrop JS, Malouin R, Weismantel D, Wadland WC: Clinicians' perceptions of factors influencing referrals to a smoking cessation program. BMC Family Practice. 2008, 9: 18-10.1186/1471-2296-9-18.CrossRefPubMedPubMedCentral Holtrop JS, Malouin R, Weismantel D, Wadland WC: Clinicians' perceptions of factors influencing referrals to a smoking cessation program. BMC Family Practice. 2008, 9: 18-10.1186/1471-2296-9-18.CrossRefPubMedPubMedCentral
23.
go back to reference Soto Mas FG, Balcazar HG, Alberola JV, Hsu CE: Correlates of tobacco cessation counseling among Hispanic physicians in the US: a cross-sectional survey study. BMC Public Health. 2008, 8: 5-10.1186/1471-2458-8-5.CrossRefPubMed Soto Mas FG, Balcazar HG, Alberola JV, Hsu CE: Correlates of tobacco cessation counseling among Hispanic physicians in the US: a cross-sectional survey study. BMC Public Health. 2008, 8: 5-10.1186/1471-2458-8-5.CrossRefPubMed
24.
go back to reference Hjalmarson A, Saloojee Y: Psychologists and tobacco: attitudes to cessation counseling and pattern of use. Prev Med. 2005, 41: 291-294. 10.1016/j.ypmed.2004.11.012.CrossRefPubMed Hjalmarson A, Saloojee Y: Psychologists and tobacco: attitudes to cessation counseling and pattern of use. Prev Med. 2005, 41: 291-294. 10.1016/j.ypmed.2004.11.012.CrossRefPubMed
25.
go back to reference Saywell RM, Jay SJ, Lukas PJ, Casebeer LL, Mybeck KC, Parchman ML, Haley AJ: Indiana family physician attitudes and practices concerning smoking cessation. Indiana Med. 1996, 89: 149-156.PubMed Saywell RM, Jay SJ, Lukas PJ, Casebeer LL, Mybeck KC, Parchman ML, Haley AJ: Indiana family physician attitudes and practices concerning smoking cessation. Indiana Med. 1996, 89: 149-156.PubMed
26.
go back to reference Strecher VJ, O'Malley MS, Villagra VG, Campbell EE, Gonzalez JJ, Irons TG, Kenney RD, Turner RC, Rogers CS, Lyles MF: Can residents be trained to counsel patients about quitting smoking? Results from a randomized trial. J Gen Intern Med. 1991, 6: 9-17. 10.1007/BF02599383.CrossRefPubMed Strecher VJ, O'Malley MS, Villagra VG, Campbell EE, Gonzalez JJ, Irons TG, Kenney RD, Turner RC, Rogers CS, Lyles MF: Can residents be trained to counsel patients about quitting smoking? Results from a randomized trial. J Gen Intern Med. 1991, 6: 9-17. 10.1007/BF02599383.CrossRefPubMed
27.
go back to reference Cummings SR, Richard RJ, Duncan CL, Hansen B, Vander Martin R, Gerbert B, Coates TJ: Training physicians about smoking cessation: a controlled trial in private practice. J Gen Intern Med. 1989, 4: 482-489. 10.1007/BF02599545.CrossRefPubMed Cummings SR, Richard RJ, Duncan CL, Hansen B, Vander Martin R, Gerbert B, Coates TJ: Training physicians about smoking cessation: a controlled trial in private practice. J Gen Intern Med. 1989, 4: 482-489. 10.1007/BF02599545.CrossRefPubMed
28.
go back to reference Steyn K, Bradshaw D, Norman R, Laubscher R, Saloojee Y: Tobacco use in South Africans in 1998: the first demographic and health survey. J Cardiovasc Risk. 2002, 9: 161-170. 10.1097/00043798-200206000-00005.CrossRefPubMed Steyn K, Bradshaw D, Norman R, Laubscher R, Saloojee Y: Tobacco use in South Africans in 1998: the first demographic and health survey. J Cardiovasc Risk. 2002, 9: 161-170. 10.1097/00043798-200206000-00005.CrossRefPubMed
29.
go back to reference Ossip-Klein DJ, McIntosh S, Utman C, Burton K, Spada J, Guido J: Smokers ages 50+: who gets physicians advice to quit?. Prev Med. 2000, 31: 364-369. 10.1006/pmed.2000.0721.CrossRefPubMed Ossip-Klein DJ, McIntosh S, Utman C, Burton K, Spada J, Guido J: Smokers ages 50+: who gets physicians advice to quit?. Prev Med. 2000, 31: 364-369. 10.1006/pmed.2000.0721.CrossRefPubMed
30.
go back to reference Ayo-Yusuf OA, Swart TJP, Pickworth WB: Nicotine delivery capabilities of smokeless tobacco products and implications for control of tobacco dependence in South Africa. Tobacco control. 2004, 13: 186-189. 10.1136/tc.2003.006601.CrossRefPubMedPubMedCentral Ayo-Yusuf OA, Swart TJP, Pickworth WB: Nicotine delivery capabilities of smokeless tobacco products and implications for control of tobacco dependence in South Africa. Tobacco control. 2004, 13: 186-189. 10.1136/tc.2003.006601.CrossRefPubMedPubMedCentral
31.
go back to reference Rothemich SF, Woolf SH, Johnson RE, Burgett AE, Flores SK, Marsland DW, Ahluwalia JS: Effect on cessation counseling of documenting smoking status as a routine vital sign: an ACORN study. Ann Fam Med. 2008, 6: 60-68. 10.1370/afm.750.CrossRefPubMedPubMedCentral Rothemich SF, Woolf SH, Johnson RE, Burgett AE, Flores SK, Marsland DW, Ahluwalia JS: Effect on cessation counseling of documenting smoking status as a routine vital sign: an ACORN study. Ann Fam Med. 2008, 6: 60-68. 10.1370/afm.750.CrossRefPubMedPubMedCentral
32.
go back to reference Ellerbeck EF, Ahluwalia JS, Jolicoeur DG, Gladden J, Mosier MC: Direct observation of smoking cessation activities in primary care practice. J Fam Pract. 2001, 50: 688-693.PubMed Ellerbeck EF, Ahluwalia JS, Jolicoeur DG, Gladden J, Mosier MC: Direct observation of smoking cessation activities in primary care practice. J Fam Pract. 2001, 50: 688-693.PubMed
33.
go back to reference Slama K, Chiang C-Y, Enarson DA: Tobacco cessation and brief advice. Int J Tuber Lung Dis. 2007, 11: 612-616. Slama K, Chiang C-Y, Enarson DA: Tobacco cessation and brief advice. Int J Tuber Lung Dis. 2007, 11: 612-616.
34.
go back to reference Parkes G, Greenhalgh T, Griffin M, Dent R: Effect on smoking quit rate of telling patients their lung age. BMJ. 2008, 336: 598-600. 10.1136/bmj.39503.582396.25.CrossRefPubMedPubMedCentral Parkes G, Greenhalgh T, Griffin M, Dent R: Effect on smoking quit rate of telling patients their lung age. BMJ. 2008, 336: 598-600. 10.1136/bmj.39503.582396.25.CrossRefPubMedPubMedCentral
35.
go back to reference Boutou AK, Tsiata EA, Pataka A, Kontou PK, Pitsiou GG, Argyropoulou P: Smoking cessation in clinical practice: predictors of six-months continuous abstinence in a sample of Greek smokers. Prim Care Respir J. 2008, 17: 32-38. 10.3132/pcrj.2008.00009.CrossRefPubMed Boutou AK, Tsiata EA, Pataka A, Kontou PK, Pitsiou GG, Argyropoulou P: Smoking cessation in clinical practice: predictors of six-months continuous abstinence in a sample of Greek smokers. Prim Care Respir J. 2008, 17: 32-38. 10.3132/pcrj.2008.00009.CrossRefPubMed
Metadata
Title
Missed opportunities for tobacco use screening and brief cessation advice in South African primary health care: a cross-sectional study
Authors
Olufemi B Omole
Kabilabe NW Ngobale
Olalekan A Ayo-Yusuf
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2010
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/1471-2296-11-94

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