Objective: To estimate the percentage of California smokers who visit physicians each year and thus determine the extent of the opportunity for physicians to advise their smoking patients to quit; to identify sociodemographic and other characteristics related to smokers' reporting that advice was given; and to look for evidence that physician advice influences quitting behavior.
Setting and design: Data were collected as part of the 1990 California Tobacco Survey, a large (n = 24,296) population-based telephone survey.
Participants: 9,796 current smokers, including 5,559 daily smokers who had visited a physician in the preceding year.
Measurements and main results: Two-thirds of all smokers had visited a physician in the year before the interview, but only about 50% of Hispanic and Asian smokers had done so. Multivariate analysis showed that advice at the last visit was independently related to older age, higher cigarette consumption, and poorer perceived health. Compared with smokers never advised to quite by a physician, those advised to quit at the last visit were 1.61 (95% confidence interval, 1.31-1.98) times more likely to report a quit attempt in the preceding year and 1.90 (95% confidence interval, 1.45-2.48) times more likely to be preparing to quit; however, those advised previously but not at the last visit showed no more quitting activity than did smokers never advised to quit.
Conclusion: Physicians have considerable opportunity to reach all demographic subgroups of the population, but the nature of the subgroups advised most (those who are older, have high consumption of cigarettes, or have poor health) suggests that physicians tend to treat such advice as a therapeutic rather than a preventive intervention. Physician advice at the most recent visit encourages patients to think about quitting and probably leads to quit attempts. Thus, it is vital that physicians perform the simple intervention of advising every smoker to quit at every visit.