CURRENT TRENDS IN TOBACCO PREVENTION AND CESSATION IN NEBRASKA PHYSICIANS OFFICES

BACKGROUND. Despite years of intervention, few studies describe the ex tent to which recommended tobacco use prevention and cessation activit ies occur in community-based family practices. This study was designed to discover current practice patterns in these areas and to describe physician outcome and efficacy expectations. METHODS. An exploratory c omparative case study of 11 family practices used direct observation o f practices and clinical encounters, chart reviews, and in-depth inter views. Qualitative and quantitative information was gathered on (1) in tensity of tobacco use prevention and cessation; (2) physicians' attit udes and beliefs regarding outcome expectations; and (3) physicians' p erceptions of their ability to counsel. Qualitative content analysis a nd descriptive statistics were used to construct case studies for comp arisons. RESULTS. Themes common to most practices included the ''provi sion of little prevention'' and ''a lack of perceived need to address smokeless tobacco.'' Responsibility for tobacco activities fell almost solely to physicians. Although physicians felt confident in their cou nseling skills, the skills they identified were fairly basic. Most phy sicians were pessimistic about the positive effects of these activitie s. None of the practices was using any specifically developed ''packag e,'' and pharmaceutical companies provided almost all patient educatio n material. There was considerable variation in intensity of activitie s because of differences in attitudes, expectation, and background. CO NCLUSIONS. To increase tobacco control activities, practice systems ne ed to be individually evaluated to identify what is needed, how it wil l fit within the practice culture, and how it can best be implemented in this specific practice. One-size-fits-all interventions probably wi ll not be widely implemented.