Cessation Counseling at US Dentist and Physician Offices
Cessation Counseling at US Dentist and Physician Offices
The TUS-CPS is a national survey of the civilian noninstitutionalized US adult population that collects a multistage stratified area probability sample of households and is conducted in person or by proxy.
We analyzed pooled data from 3 waves of the TUS-CPS for adults aged 18 years or older. Statistics for each wave were January 2011 (n = 83 000; household nonresponse = 8.6%; individual nonresponse = 40.2%), August 2010 (n = 63 000; household nonresponse = 8.0%; individual nonresponse = 38.4%), and May 2010 (n = 84 000; household nonresponse = 7.6%; individual nonresponse = 37.7%). We excluded all respondents interviewed by proxy (27%, 25%, and 24% of total interviews in January 2011, August 2010, and May 2010, respectively). We adjusted data for nonresponse and weighted them according to the nonresponse weight in the TUS-CPS that included only self-respondents.
Sociodemographic Characteristics. The survey collected data on race/ethnicity (Hispanic, White, Black, American Indian/Alaska Native, Asian or Native Hawaiian/other Pacific Islander, or multiple race), age (≤ 24, 25–44, 45–64, or ≥ 65 years), gender (male or female), educational attainment (< 12 years, no diploma; 12 years–general educational development certificate; or > 12 years), and marital status (married; widowed, divorced, or separated; or single).
Current Tobacco Use. Current cigarette smokers were respondents who had smoked at least 100 cigarettes during their lifetime and who smoked daily or on some days at the time of the survey. We recoded average number of cigarettes smoked per day as 1 to 10, 11 to 20, 21 to 30, and 31 or more. The survey also asked whether respondents currently used other noncigarette tobacco products daily or on some days. These noncigarette tobacco products were pipes, water pipes (hookahs), cigars, and smokeless tobacco products.
Patient-reported Visit to a Physician or Dentist in the Past 12 Months. The survey ascertained visits to physicians and dentists from yes responses to the questions, "In the past 12 months, have you seen a medical doctor?" and "In the past 12 months, have you seen a dentist?" We created from these responses a 4-stratum composite variable to describe respondents' visit to a health care professional in the past 12 months: (1) no visit to either a dentist or a physician, (2) visit to a dentist only, (3) visit to a physician only, and (4) visit to both a physician and a dentist.
Patient-reported Receipt of Advice Intervention From a Physician or Dentist. The survey assessed receipt of the advice intervention from a physician or a dentist only among those who had visited the relevant provider in the past 12 months, as a yes response to the question, "During the past 12 months, did any medical doctor advise you to stop smoking?" or "During the past 12 months, did any dentist advise you to stop smoking?"
Patient-reported Receipt of Assistance Interventions From a Physician or Dentist. Among current smokers who had visited a physician or a dentist in the past 12 months and were advised to quit smoking, the survey assessed implementation of assistance measures with a stem question, followed by several multiple-choice options. The stem questions for physicians' and dentists' patients, respectively, were "In the past 12 months, when a medical doctor advised you to quit smoking, did the doctor also …" and "In the past 12 months, when a dentist advised you to quit smoking, did the dentist also …"
Multiple-choice options were identical for both stem questions: (1) "Suggest that you call or use a telephone help line or quit line?" (2) "Suggest that you use a smoking cessation class, program, or counseling?" (3) "Suggest that you set a specific date to stop smoking?" (4) "Recommend or prescribe a nicotine product such as a patch, gum, lozenge, nasal spray or inhaler?" and (5) "Prescribe a pill such as Chantix, Varenicline, Zyban, Bupropion, or Wellbutrin?"
We categorized an affirmative response to either of the last 2 options as a positive indication that a physician or dentist had assisted the patient with a medication for smoking cessation. We considered patients to have received any assistance measure if they selected 1 or more of the 5 options.
Smoking Cessation Aids Used by Past-year Quit Attempters. The survey defined a quit attempt among current smokers as an affirmative response to the question, "During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking?"
Among past-year quit attempters, the survey ascertained the cessation aid used with the question, "Thinking back to the (last time/time) you tried to quit smoking in the past 12 months did you use any of the following products …" Options were
We classified reports by past-year quit attempters that they used any of options 1 to 6 as use of medication as a smoking cessation aid. We categorized quit attempters who selected 1 or more of options 1 to 13 to have used any smoking cessation aid.
We used percentages and 95% confidence intervals (CIs) to assess receipt of advice and assistance cessation interventions from a dentist or physician. We considered estimates with relative standard errors of 40% or greater statistically unreliable. We compared estimates with a 2-sample t test (P < .05). We used sampling weights to extrapolate the estimated number of smokers who had visited a physician or a dentist during 2010 to 2011 but did not receive any cessation counseling.
To further compare cessation-counseling behaviors between dentists and physicians, we performed multivariable logistic regression analyses among past-year quit attempters. The outcomes were the various cessation aids used in the past 12 months, and the primary predictor was the composite variable describing health professional visits made in the past 12 months, with adjustment for types of tobacco used, cigarettes per day, gender, age, race/ethnicity, US census region, education, and marital status (P < .05). We weighted all data with the survey (SVY commands) mode in Stata version 11 (StataCorp LP, College Station, TX).
Methods
The TUS-CPS is a national survey of the civilian noninstitutionalized US adult population that collects a multistage stratified area probability sample of households and is conducted in person or by proxy.
We analyzed pooled data from 3 waves of the TUS-CPS for adults aged 18 years or older. Statistics for each wave were January 2011 (n = 83 000; household nonresponse = 8.6%; individual nonresponse = 40.2%), August 2010 (n = 63 000; household nonresponse = 8.0%; individual nonresponse = 38.4%), and May 2010 (n = 84 000; household nonresponse = 7.6%; individual nonresponse = 37.7%). We excluded all respondents interviewed by proxy (27%, 25%, and 24% of total interviews in January 2011, August 2010, and May 2010, respectively). We adjusted data for nonresponse and weighted them according to the nonresponse weight in the TUS-CPS that included only self-respondents.
Measures
Sociodemographic Characteristics. The survey collected data on race/ethnicity (Hispanic, White, Black, American Indian/Alaska Native, Asian or Native Hawaiian/other Pacific Islander, or multiple race), age (≤ 24, 25–44, 45–64, or ≥ 65 years), gender (male or female), educational attainment (< 12 years, no diploma; 12 years–general educational development certificate; or > 12 years), and marital status (married; widowed, divorced, or separated; or single).
Current Tobacco Use. Current cigarette smokers were respondents who had smoked at least 100 cigarettes during their lifetime and who smoked daily or on some days at the time of the survey. We recoded average number of cigarettes smoked per day as 1 to 10, 11 to 20, 21 to 30, and 31 or more. The survey also asked whether respondents currently used other noncigarette tobacco products daily or on some days. These noncigarette tobacco products were pipes, water pipes (hookahs), cigars, and smokeless tobacco products.
Patient-reported Visit to a Physician or Dentist in the Past 12 Months. The survey ascertained visits to physicians and dentists from yes responses to the questions, "In the past 12 months, have you seen a medical doctor?" and "In the past 12 months, have you seen a dentist?" We created from these responses a 4-stratum composite variable to describe respondents' visit to a health care professional in the past 12 months: (1) no visit to either a dentist or a physician, (2) visit to a dentist only, (3) visit to a physician only, and (4) visit to both a physician and a dentist.
Patient-reported Receipt of Advice Intervention From a Physician or Dentist. The survey assessed receipt of the advice intervention from a physician or a dentist only among those who had visited the relevant provider in the past 12 months, as a yes response to the question, "During the past 12 months, did any medical doctor advise you to stop smoking?" or "During the past 12 months, did any dentist advise you to stop smoking?"
Patient-reported Receipt of Assistance Interventions From a Physician or Dentist. Among current smokers who had visited a physician or a dentist in the past 12 months and were advised to quit smoking, the survey assessed implementation of assistance measures with a stem question, followed by several multiple-choice options. The stem questions for physicians' and dentists' patients, respectively, were "In the past 12 months, when a medical doctor advised you to quit smoking, did the doctor also …" and "In the past 12 months, when a dentist advised you to quit smoking, did the dentist also …"
Multiple-choice options were identical for both stem questions: (1) "Suggest that you call or use a telephone help line or quit line?" (2) "Suggest that you use a smoking cessation class, program, or counseling?" (3) "Suggest that you set a specific date to stop smoking?" (4) "Recommend or prescribe a nicotine product such as a patch, gum, lozenge, nasal spray or inhaler?" and (5) "Prescribe a pill such as Chantix, Varenicline, Zyban, Bupropion, or Wellbutrin?"
We categorized an affirmative response to either of the last 2 options as a positive indication that a physician or dentist had assisted the patient with a medication for smoking cessation. We considered patients to have received any assistance measure if they selected 1 or more of the 5 options.
Smoking Cessation Aids Used by Past-year Quit Attempters. The survey defined a quit attempt among current smokers as an affirmative response to the question, "During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking?"
Among past-year quit attempters, the survey ascertained the cessation aid used with the question, "Thinking back to the (last time/time) you tried to quit smoking in the past 12 months did you use any of the following products …" Options were
"A nicotine patch?"
"A nicotine gum or nicotine lozenge?"
"A nicotine nasal spray or nicotine inhaler?"
"A prescription pill, called Chantix or Varenicline?"
"A prescription pill, called Zyban, Bupropion, or Wellbutrin?"
"Another prescription pill?"
"A telephone help line or quit line?"
"One-on-one counseling?"
"A stop smoking clinic, class, or support group?"
"Help or support from friends or family?"
"Internet or web-based program?"
"Books, pamphlets, videos or other materials?" and
"Acupuncture or hypnosis?"
We classified reports by past-year quit attempters that they used any of options 1 to 6 as use of medication as a smoking cessation aid. We categorized quit attempters who selected 1 or more of options 1 to 13 to have used any smoking cessation aid.
Data Analyses
We used percentages and 95% confidence intervals (CIs) to assess receipt of advice and assistance cessation interventions from a dentist or physician. We considered estimates with relative standard errors of 40% or greater statistically unreliable. We compared estimates with a 2-sample t test (P < .05). We used sampling weights to extrapolate the estimated number of smokers who had visited a physician or a dentist during 2010 to 2011 but did not receive any cessation counseling.
To further compare cessation-counseling behaviors between dentists and physicians, we performed multivariable logistic regression analyses among past-year quit attempters. The outcomes were the various cessation aids used in the past 12 months, and the primary predictor was the composite variable describing health professional visits made in the past 12 months, with adjustment for types of tobacco used, cigarettes per day, gender, age, race/ethnicity, US census region, education, and marital status (P < .05). We weighted all data with the survey (SVY commands) mode in Stata version 11 (StataCorp LP, College Station, TX).