Participating physicians were on average 51 years old, 78% were men, 29% were general practitioners and 71% were specialists, 11% were daily smokers, 16% were occasional smokers and 73% were nonsmokers.
Most (82%) of the participants in the intervention group acknowledged receipt of the stickers, and 20% reported using the stickers. When they used the stickers, physicians reported applying them on average to 43% of their smoking patients' charts (median, 29%; SD, 39%).
Reasons for not using the stickers were that physicians judged it unacceptable to label the smokers' charts this way (27% of physicians), that they were not accustomed to using stickers (22%), and that the stickers were considered useless (14%). Answers to an open-ended question (n = 51) indicated that some physicians had already recorded patients' smoking status on the charts (25 comments), and that others were reluctant to label smokers' charts (10 comments, such as “Anti-smoker racism,” or “It alters the relationship with the patient”).
Overall, physicians did not change their reported smoking prevention activities between baseline and follow-up surveys. However, physicians in the intervention group who reported using the stickers also stated that they advised more smokers to quit after the intervention (89%) than before the intervention (80%, P = .02)().
Change in Smoking Prevention Activities Self-Reported by Physicians Who Received “Smoker” Stickers and Used Them to Label Their Patients' Charts, and in Physicians Who Received the Stickers but Did Not Use Them
In the intervention group, the reported proportion of smokers' charts on which the smoking status was written in an “immediately visible way” decreased by 14%, but remained unchanged in the control group (between-group difference, P = .001). This decrease occurred only among physicians in the intervention group who said that they did not use the stickers ().
In a retrospective assessment made in the follow-up survey, the proportion of physicians who reported advising more of their smoking patients to quit smoking than at baseline was similar in the 2 study groups ().
Impact of Mailing a Box of “Smoker” Stickers to Physicians on the Self-reported Smoking Prevention Activities Performed by Private Practice Practitioners
Self-reported use of the stickers was not associated with specialist/generalist status, or with age or gender. Physicians who smoked reported using the stickers less often than nonsmokers, but the difference was not statistically significant (15% vs 30%, P = .14).