Abstract
Smokers are often advised to quit in a discussion of future health risks. The authors tested whether adding information about personal effects of smoking would motivate hospital outpatients to stop smoking more than advice about potential hazards would. Ninety smokers in a general screening clinic were randomized to receive education alone or education plus an additional motivational intervention that contained immediate feedback about the smoker’s exhaled carbon monoxide (CO) values, spirometry results, and pulmonary symptoms. A self-report of smoking status was obtained one, four, and 12 months after the intervention. In addition, at 12 months, exhaled CO measurements were made. Smokers who received the additional motivational intervention were more than twice as likely to report quitting some time during the 12-month follow-up (40% vs. 16%, p=0.015). At 12 months, 33% of the intervention group and 10% of the control group smokers tested had achieved Co-validated cessation (p=0.03). Counting all patients not contacted as continuing to smoke, the percentages were 20% vs. 7% (p=0.06). These practical feedback methods to motivate cessation deserve testing in other settings.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Schwartz JL. Review and evaluation of smoking cessation methods: the United States and Canada, 1978–1985. Washington DC: Division of Cancer Prevention and Control, National Cancer Institute, U.S. Department of Health and Human Services, 1987; NIH Publication no. 87–2940.
Schachter S. Recidivism and self-cure of smoking and obesity. Am Psychol. 1982;27:436–44.
Ockene JK. Smoking intervention: the expanding role of the physician. Am J Public Health. 1987;77:782–3.
Janz NK, Becker MH, Kirscht JP, Eraker SA, Billi JE, Woolliscroft JO. Evaluation of a minimal-contact smoking cessation intervention in an outpatient setting. Am J Public Health. 1987;77:805–9.
Pederson LL. Compliance with physician advice to quit smoking: a review of the literature. Prev Med. 1982;11:71–84.
Russell MAH, Wilson C, Taylor C, Baker CD. Effect of general practitioners’ advice against smoking. Br Med J. 1979;2:231–5.
Greene HL, Goldberg RJ, Ockene JK. Cigarette smoking: the physician’s role in cessation and maintenance. J Gen Intern Med. 1988;3:75–87.
Kottke TE, Battista RN, DeFriese GH, Brekke ML. Attributes of successful smoking cessation interventions in medical practice: a meta-analysis of 39 controlled trials. JAMA. 1988;259:2882–9.
Weinberger M, Greene JY, Hamlin JJ, Jerin MJ. Health beliefs and smoking behavior. Am J Public Health. 1981;71:1253–5.
Altman DG, King AC. Approaches to compliance in primary prevention. J Compl Health Care. 1986;1:55–73.
Morris JF, Temple W. Spirometric “lung age” estimation for motivating smoking cessation. Prev Med. 1985;14:660–2.
Pettry TL, Cherniack RM. Let’s identify COPD early! Clin Notes Respir Dis. 1982;21:8–9.
Paxton R, Scott S. Nonsmoking reinforced by improvements in lung function. Addict Behav. 1981;6:313–5.
Morris JF, Sturman W. Spirometry and respiratory questionnaire: value for screening and smoking cessation. (abstract) Am Rev Respir Dis. 1974;109:702.
Petty TL, Pierson DJ, Dick NP, Hudson LD, Walker SH. Follow-up evaluation of a prevalence study for chronic bronchitis and chronic airway obstruction. Am Rev Respir Dis. 1976;114:881–90.
Hepper NGG, Drage CW, Davies SF, et al. Chronic obstructive pulmonary disease: a community-oriented program including professional education and screening by a voluntary health agency. Am Rev Respir Dis. 1980;121:97–104.
Loss RW, Hall WJ, Speers DM. Evaluation of early airway disease in smokers: cost effectiveness of pulmonary function testing. Am J Med Sci. 1979;278:27–37.
Li VC, Kim YJ, Ewart CK, et al. Effects of physician counseling on the smoking behavior of asbestos-exposed workers. Prev Med. 1984;13:462–76.
Stitzer ML, Bigelow GE. Contingent reinforcement for reduced carbon monoxide levels in cigarette smokers. Addict Behav. 1982;7:403–12.
Vogt TM, Selvin S, Hulley SB. Comparison of biochemical and questionnaire estimates of tobacco exposure. Prev Med. 1979;8:23–33.
Bauman KE, Bryan ES, Dent CW, Koch GG. The influence of observing carbon monoxide level on cigarette smoking by public prenatal patients. Am J Public Health. 1983;73:1089–91.
Jamrozik K, Vessey M, Fowler G, Wald N, Parker G, Van Vunakis H. Controlled trial of three different antismoking interventions in general practice. Br Med J. 1984;288:1499–1503.
Belcher DW, Inui TS, Carter WB. Disease prevention and health maintenance program trial: HSR & D project IIR#81–619 final report. Seattle, WA: Northwest Health Services Research and Development Field Program, Veterans Administration Medical Center, 1987.
American Lung Association. Freedom from smoking in 20 days: self-help quit smoking program. New York: American Lung Association, 1980.
Morris JF, Koski A, Johnson LC. Spirometric standards for healthy nonsmoking adults. Am Rev Respir Dis. 1971;103:57–67.
Morris JF, Koski A, Breese JD. Normal values and evaluation of forced end-expiratory flow. Am Rev Respir Dis. 1975;111:755–62.
Fletcher C, Peto R, Tinker C, Speizer FE. The natural history of chronic bronchitis and emphysema: an eight-year study of early chronic obstructive lung disease in working men in London. New York: Oxford University Press, 1976.
Medical Research Council Committee on the Aetiology of Chronic Bronchitis. Standardized questionaires on respiratory symptoms. Br Med J. 1960;2:1665.
Marascuilo LA: Statistical methods for behavior science research. New York: McGraw Hill, 1971.
Ershoff DH, Mullen PD, Quinn VP. A randomized trial of a serialized self-help cessation program for pregnant women in an HMO. Am J Public Health. 1989;79:182–7.
Glynn SM, Gruder CL, Jegerski JA. Effects of biochemical validation of self-reported cigarette smoking on treatment success and on misreporting abstinence. Health Psychol. 1986;5:125–36.
Petitti DB, Friedman GD, Kahn W. Accuracy of information on smoking habits provided on self-administered research questionnaires. Am J Public Health. 1981;71:308–11.
Pederson LL, Baskerville JC, Wanklin JM. Multivariate statistical models for predicting change in smoking behavior following physician advice to quit smoking. Prev Med. 1982;11:536–49.
Richmond RL, Webster IW. A smoking cessation programme for use in general practice. Med J Aust. 1985;142:190–4.
Lam W, Sze PC, Sacks HS, Chalmers TC. Meta-analysis of randomised controlled trials of nicotine chewing gum. Lancet. 1987;2:27–9.
Glassman AH, Stetner F, Walsh BT, et al. Heavy smokers, smoking cessation, and clonidine: results of a double-blind randomized trial. JAMA. 1988;259:2863–6.
Marlatt GA, Gordon J. Relapse prevention. New York: Guilford Press, 1985.
Author information
Authors and Affiliations
Additional information
Received from the Nursing Service, Department of Veterans Affairs (VA) Medical Center and the Division of General Internal Medicine, Department of Medicine, University of Washington, VA Medical Center, Seattle, Washington.
Preliminary results presented as a Poster Presentation at the annual meeting of the American Thoracic Society, May 11, 1986.
Supported by VA Health Services Research and Development funds.
Rights and permissions
About this article
Cite this article
Risser, N.L., Belcher, D.W. Adding spirometry, carbon monoxide, and pulmonary symptom results to smoking cessation counseling. J Gen Intern Med 5, 16–22 (1990). https://doi.org/10.1007/BF02602303
Issue Date:
DOI: https://doi.org/10.1007/BF02602303