To the knowledge of these investigators, this is the first study assessing the factors that may be associated with tobacco counseling practices among Hispanic physicians in the US. Despite the exploratory nature and limitations of the study, results may assist in the developing of effective approaches for training Hispanic physicians in tobacco counseling. Given the important role physicians play in smoking cessation [13
], better trained Hispanic physicians may positively impact tobacco use among Hispanic patients. Additionally, this study provided preliminary data which support the need for future research related to Hispanic physicians and tobacco control.
The majority (73%) of respondents recognized that the advice of physicians increases quitting rates. These results are consistent with other published papers reporting on high perceived responsibility to educate patients who smoke [30
]. Although some authors have reported an association between perceived professional responsibility [31
] and attitudes towards smoking cessation counseling [9
], the present study did not find a significant correlation between responsibility/attitudes and tobacco-related practices. Furthermore, this variable was not significantly correlated with any of the other two domains: knowledge/skills and self-efficacy.
Regarding self-efficacy, respondents had low confidence in convincing smoker patients to quit or lower their exposure to secondhand smoke. This study found a significant correlation between tobacco practices and self-efficacy, which is consistent with the literature. Physicians who report a feeling of self-efficacy in the area of tobacco use and prevention are in fact more likely to intervene with patients [5
]. Self-efficacy is defined as the confidence a person has that he/she can perform a particular activity, and overcome challenging situations to perform that activity [34
Results indicate that physicians' familiarity with standard cessation protocols has a significant effect on their tobacco-related practices. These results are consistent with other studies that have reported significant correlations between practice and knowledge, as well as skills and training [3
]. Although many tobacco-related studies have found significant correlations between knowledge and practice, it is generally assumed that knowledge is not independently predictive of behavior. Many authors have argued that clinicians with greater knowledge have probably received more training and are more committed and prepared to intervene [5
]. In this study, knowledge/skills was also significantly correlated with self-efficacy, which may explain why participants with greater knowledge also reported better performance.
As regards the TM, none of the respondents were familiar enough with the TM to use it. These results are consistent with the literature, which has reported on the low use by physicians of evidence-based approaches to smoking cessation [15
], and on the ineffectiveness of professional/clinical practice guidelines in changing physicians' practices [38
Finally, the results of the multiple linear regressions revealed that the two single independent variables that best correlated with practice were self-efficacy and gender. Other studies among health providers have found no gender differences in tobacco performance [5
], and indicate that gender does not predict self-reported smoking counseling behavior [38
]. A recent study found that female physicians were more active in counseling patients on smoking and other preventive behaviors [44
]. In contrast, this study found better practice among participant male physicians. These differences may be due to the cultural background of our sample, consisting of physicians of Hispanic heritage: this issue warrants further research. Note that according to the US Office of Personnel Management, "Hispanic" is used to refer to "a person of Mexican, Puerto Rican, Cuban, Central or South American or Spanish culture or origin, regardless of race [45
]." This study asked participants to report their Ethnicity by checking "Hispanic/Latino" or "Other."