Smoking status as a vital sign

OBJECTIVE: We conducted this study to determine if a smoking status stamp w ould prompt physicians to increase the number of times they ask, advise, as sist, and arrange follow-up for African-American patients about smoking-rel ated issues. DESIGN:An intervention study with a posttest assessment (after the physicia n visit) conducted over four 1-month blocks. The control period was the fir st 2 weeks of each month, while the following 2 weeks served as the interve ntion period. SETTING: An adult walk-in clinic in a large inner-city hospital. PARTICIPANTS: We consecutively enrolled into the study 2,595 African-Americ an patients (1,229 intervention and 1,366 control subjects) seen by a house staff physician. INTERVENTIONS:A smoking status stamp placed on clinic charts during the int ervention period. MAIN RESULTS:Forty-five housestaff rotated through the clinic in 1-month bl ocks, In univariate analyses, patients were significantly more likely to be asked by their physicians if they smoke cigarettes during the intervention compared with the control period, 78.4% versus 45.6% (odds ratio [OR] 4.28 : 95% confidence interval [CI] 3.58, 5.10), Patients were also more likely to be told by their physician to quit, 39.9% versus 26.9% (OR 1.81; 95% CI 1.36, 2.40), and have followup arranged. 12.3% versus 6.2% (OR 2.16: 95% CI 1.30, 3.38). CONCLUSIONS: The stamp had a significant effect on increasing rates of aski ng about cigarette smoking, telling patients to quit, and arranging follow- up for smoking cessation. However, the stamp did not improve the low rate a t which physicians offered patients specific advice on how to quit or in se tting a quit date.