Physicians taught as residents to conduct smoking cessation intervention: a follow-up study

Background. The influence of residency training on use of smoking cessation intervention (SCI) in future practice is unexamined. Methods. We surveyed 291 physicians who participated in SCI research during residency between 1986 and 1996. Half received SCI training; half did not. Best practice included: (1) identifying smokers; (2) advising cessation; (3) assisting with a plan; (4) arranging follow-up. Results. Forty-two percent of respondents were using best practices. Training per se was not associated with current use of best practices (relative RISK = 1.04; adjusted relative risk [ARR] = 0.91). However, those who reported use of best practices in residency were twice as likely to currently use best practices [ARR = 2.0; 95% confidence interval (CI) 1.3, 2.9]. Resources associated with use of best practices included patient education materials (ARR = 1.8; CI 1.1, 2.7), staff familiar with SCI (ARR = 1.8; CI 1.2, 2.6), and opportunity for referral to cessation counselors/programs (ARR = 1.3; CI 1.0, 1.9). Resources related in a dose–response fashion to best practices: 24% of those without resources provide best SCI, 32% with any one resource, 51% with any two, and 74% with all three. Conclusions. To expand use of best SCI, residencies must ensure physicians use SCI skills, and health care systems must provide resources to facilitate intervention.