Milióny fajčiarov nehovoria lekárom, že fajčia

11.1.2012
Milióny fajčiarov nehovoria lekárom, že fajčia
Millions of Smokers Don´t Tell Docs that They Light Up

By Crystal Phend, Senior Staff Writer, MedPage Today

More than one smoker in 10 tries to hide his or her tobacco use from physicians, according to a survey by an anti-tobacco group. Top reasons cited by the 13% who said they concealed their smoking habit were wanting to avoid a lecture and being ashamed, the American Legacy Foundation reported. The findings mean that doctors and nurses are missing important health information on more than six million U.S. smokers, warned Cheryl G. Healton, DrPH, president of the organization.

"Healthcare providers play a critical role in reaching smokers with appropriate messages and resources for quitting, especially now that insurance coverage has expanded to include some smoking cessation treatments," she said in a press release. The nationally representative panel of 3,146 smokers and former smokers surveyed online in 2011 was conducted with support from Pfizer, maker of the smoking-cessation drug varenicline (Chantix).

Most of the 1,370 respondents who answered the survey question on whether they had ever kept their smoking status a secret from a healthcare provider said they felt comfortable discussing smoking (53.4%).

Not surprisingly, of those who had kept their smoking status a secret, fewer were comfortable discussing it with clinicians (27.4% of 177).

Compared with individuals who did disclose their smoking, those who didn't were:

• More likely to be light smokers (69.9% 10 or fewer cigarettes per day, P=0.0074)
• Younger (P<0.001 for trend)
• More commonly female (57.6% versus 45.9%, P=0.004)
• More educated (65.0% versus 53.5% at least some college, P=0.009 for trend)
• Less likely to have a minor child (58.8% versus 71.8%, P

They also were more likely to report feeling socially stigmatized than smokers who hadn't tried to keep a healthcare professional in the dark about their habit (35% versus 14% reported high stigma).

Reasons cited for keeping smoking status to themselves were:

• Not wanting a lecture (65.8%)
• Feeling ashamed about smoking (41.5%)
• Not being ready to quit at the time (40.0%)
• Being scared to admit smoking (20.2%)

Yet this group who wouldn't own up to smoking to a nurse or doctor appeared to be the patients who might be most open to getting help to quit. They were more likely to have tried to quit over the past year than those who had always disclosed their smoking status (58.8% versus 36.7%, P=0.0001). They were also more likely to intend to quit (30.5% versus 15.7% in the next 30 days, P=0.0007 for trend).

"Many smokers know why they should quit, but often don't know how," the Legacy report noted. "Healthcare providers have an important role to play in helping smokers take that first step and helping smokers get on the path to quitting successfully."

Tips for clinicians to reach these patients included:

• Ask every patient about smoking status
• Talk openly about smoking
• Be positive and encouraging when advising smokers to quit
• Encourage smokers to not give up trying to quit
• Refer smokers to appropriate tobacco cessation treatment based on willingness to quit and other factors
• Arrange for necessary follow-up contact to help prevent relapse and troubleshoot if problems arise

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