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Is Some Provider Advice on Smoking Cessation Better Than No Advice? An Instrumental Variable Analysis of the 2001 National Health Interview Survey

Authors

  • Yuhua Bao,

    1. Center for Community Partnerships in Health Promotion, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, 1100 Glendon Ave, Ste 2010, Los Angeles, CA 90024-3524,
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    • Address correspondence to Yuhua Bao, Ph.D., Center for Community Partnerships in Health Promotion, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, 1100 Glendon Ave, Ste 2010, Los Angeles, CA 90024-3524. Naihua Duan, Ph.D., is with the Center for Community Health, Jane & Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA. Dr. Duan is also with Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA and with the Department of Biostatistics, School of Public Health, Los Angeles, CA 90024-6543. Sarah A. Fox, Ed.D., M.S.P.H., is with the Center for Community Partnerships in Health Promotion, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024-3524.

  • Naihua Duan,

    1. Center for Community Health, Jane & Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA,
    2. Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA Department of Biostatistics, School of Public Health, Los Angeles, CA 90024-6543
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  • Sarah A. Fox

    1. Center for Community Partnerships in Health Promotion, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024-3524
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Abstract

Research Objective. To estimate the effect of provider advice in routine clinical contacts on patient smoking cessation outcome.

Data Source. The Sample Adult File from the 2001 National Health Interview Survey. We focus on adult patients who were either current smokers or quit during the last 12 months and had some contact with the health care providers or facilities they most often went to for acute or preventive care.

Study Design. We estimate a joint model of self-reported smoking cessation and ever receiving advice to quit during medical visits in the past 12 months. Because providers are more likely to advise heavier smokers and/or patients already diagnosed with smoking-related conditions, we use provider advice for diet/nutrition and for physical activity reported by the same patient as instrumental variables for smoking cessation advice to mitigate the selection bias. We conduct additional analyses to examine the robustness of our estimate against the various scenarios by which the exclusion restriction of the instrumental variables may fail.

Principal Findings. Provider advice doubles the chances of success in (self-reported) smoking cessation by their patients. The probability of quitting by the end of the 12-month reference period increased from 6.9 to 14.7 percent, an effect that is of both statistical (p<.001) and clinical significance.

Conclusions. Provider advice delivered in routine practice settings has a substantial effect on the success rate of smoking cessation among smoking patients. Providing advice consistently to all smoking patients, compared with routine care, is more effective than doubling the federal excise tax and, in the longer run, likely to outperform some of the other tobacco control policies such as banning smoking in private workplaces.

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