Smoking prevention counseling practices of Montreal general practitioners

BACKGROUND: Primary care physicians are potentially important sources of interventions aimed at preventing youth smoking. Yet recent surveys suggest that physician smoking prevention practices are less than optimal. OBJECTIVES: To document prevention counseling practices and to identify correlates of these activities in a random sample of general practitioners in Montreal, Quebec. METHODS: A cross-sectional mail survey. RESULTS: Of 440 eligible general practitioners (GPs), 337 (77%) completed the questionnaire. General practitioners were more likely to ascertain the smoking status of adolescents (70.9%) than preadolescents (35.7%). Although about half of the GPs offered advice to prevent smoking onset in young adults (48.6%) and adolescents (48.3%), fewer did so for preadolescents (34.4%); only 12.1% advised parents to discuss smoking onset with their children. Correlates of ascertaining smoking status included female sex (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.07-3.41), lower proportion of walk-in patients (OR, 2.73; 95% CI, 1.31-5.80), awareness of the "stage of behavior change" model (OR, 2.17; 95% CI, 1.18-4.04), and higher self-efficacy (OR, 4.12, 95% CI, 2.00-8.69). Correlates of provision of prevention advice included more hours spent in direct patient care (OR, 1.93; 95% CI, 1.13-3.34), favorable beliefs and attitudes (OR, 1.73; 95% CI, 1.06-2.83), and higher self-efficacy (OR, 4.32; 95% CI, 2.25-8.44). CONCLUSIONS: Our results point to the need for renewed efforts to enhance preventive efforts in primary care settings. Intervention programs for GPs should emphasize overcoming unfavorable beliefs and attitudes and low self-efficacy. Future research should evaluate the effect of brief prevention counseling adapted to increasingly busy practices.