Cabana MD, Rand C, Slish K, et al. Pediatrics. 2004;113:78–81
Purpose of the Study.
Although environmental tobacco smoke is a known risk factor for asthma exacerbations among children, pediatricians infrequently advise parents who smoke to discontinue smoking. It has been shown that high physician self-efficacy or self-confidence in the counseling of parents regarding smoking discontinuation is related to increased physician screening and counseling on this issue. It is unclear, however, which factors are associated with high physician self-efficacy for counseling (eg, previous training in smoking cessation counseling or number of years in pediatric practice). The objective was to identify parameters related to physician self-efficacy in smoking cessation counseling.
This was a cross-sectional survey of a national random cohort of 829 primary care physicians.
The response rate was 55% (457 of 829 physicians). The percentages of physicians with high levels of self-efficacy for screening parents and children to identify smokers were 87% and 84%, respectively. The percentages of physicians with high levels of self-efficacy for advising parents and patients about smoking cessation were 59% for both. Previous training in smoking cessation counseling was associated with higher levels of self-efficacy for all 4 skills assessed, including inquiring about the patient’s smoking status (odds ratio [OR]: 3.91; 95% confidence interval: 1.63–9.37), inquiring about parents’ smoking status (OR: 2.51), counseling the patient to quit smoking (OR: 5.30), and counseling a parent to quit smoking (OR: 4.96). The number of years since completing residency training was not related to greater self-efficacy.
The authors concluded that formal training in smoking cessation had significant effects on physician self-efficacy with respect to smoking discontinuation, throughout physicians’ professional careers.
The study clearly demonstrated that levels of physician self-efficacy in both screening for and counseling about smoking cessation were significantly enhanced by formal training in this area. The study was limited in that it might not be representative of all pediatricians, because the respondents were more likely to be board-certified in pediatrics than were nonrespondents. In addition, the response rate was 55%, which could limit generalizability. Although there are many examples of formal training programs in smoking cessation counseling, less than one-half of pediatric residency programs currently offer any formal training in smoking cessation counseling. This study suggests that this should be made a priority for all training programs.