Smoking Among Physicians Is at All-Time Low

ORLANDO, FLA. – The prevalence of smoking among American primary care physicians has fallen to an all-time low of 2%, Steven A. Schroeder, M.D., announced at Wonca 2004, the conference of the World Organization of Family Doctors.

“That's astonishing. Even nurses, who used to have a very high rate of smoking, are down to 13%. The U.S. population rate is 23%. So just think of what the public health benefits would be if smoking rates among the public approached those of health professionals,” observed Dr. Schroeder, Distinguished Professor of Health and Health Care at the University of California, San Francisco, and national head of the university's Smoking Cessation Leadership Center.

But although very few health professionals smoke today, it's equally true that most don't do a very good job of helping smokers quit. Yet it takes less than a minute to routinely ask patients if they smoke, urge them to quit, hand them the phone number of the national quit line–1-800-QUIT NOW–and tell them to call it when they're ready.

“It works. At UCSF we call it 'Take 30 seconds and save a life,'” the general internist said in his keynote address at Wonca's global tobacco forum.

He praised the free telephone quit lines as the single most cost-effective smoking cessation intervention. The trouble is, most smokers don't even know they exist. Neither do most physicians.

“Telephone quit lines are a terrific, underused, and underrecognized resource in the United States, Canada, and Europe. They're staffed by trained counselors, often with a full year of training. These people are avid. I called one quit line, simulating that I was a smoker. I've visited the ones in California and the one the American Cancer Society has in Austin, Tex. They're really good,” he stressed.

Smokers much prefer using a quit line to going to a physician's office for counseling. Phone counseling is more convenient, it's free, and it's anonymous, so a smoker who fails in the attempt to quit doesn't feel stigma.

Getting prescription smoking-cessation agents to smokers who use a telephone quit line can be a challenge. The solution in California has been to send pharmacy vouchers for bupropion or nicotine patch therapy to indigent Medicaid patients upon completion of a 40-minute phone session with a counselor.

In addition to telephone quit lines, another measure shown to help smokers quit is price increases. For every 10% jump in the price of a pack of cigarettes, there is roughly a 4% decline in purchases. “It really does work. It's a major deterrent,” Dr. Schroeder said.

Citizen advocacy for clean indoor air is a potent issue. Tobacco industry documents indicate this is what worries them most. Why? Because it's an issue that engages nonsmokers.

Other measures that cut down on the prevalence of smoking include litigation and hip countermarketing advertisements. One reason physicians and nurses aren't better at getting patients to quit smoking is a widespread sense of discouragement about the low successful quit rate. Dr. Schroeder urged physicians to reframe the issue in a glass-is-half-full fashion.

“It's true that only 2%-3% of U.S. smokers are successfully able to quit on their own each year. But 70% of the 46 million smokers want to quit. And if you do the public health math, in fact, no other public health effort is as successful in terms of public benefit as getting people to stop smoking,” he said.

Dr. Schroeder predicted physicians are about to gain a major new ally in the tobacco wars. New, more effective smoking-cessation drugs in the developmental pipeline are likely to finally bring the pharmaceutical industry aboard in opposition to the tobacco industry.

A formidable challenge will be to tackle the problem of smoking among psychiatric patients. It's estimated that 44% of all cigarettes smoked in the U.S. are consumed by people with psychiatric illness and/or substance abuse.

Psychiatric patients not only have an inordinately high prevalence of smoking, they also tend to smoke much more heavily than other smokers.

“More alcoholics die of smoking illnesses than they do of alcohol-related illnesses,” Dr. Schroeder noted.