Physicians’ beliefs regarding the effectiveness of tobacco dependence interventions were generally supported by evidence-based data for most cessation medications and counseling treatments (Table ). The beliefs regarding some nicotine medications and telephone and group treatments had some inconsistencies with the literature. Perceived effectiveness of the various cessation medications is supported by research evidence.11–15
The belief that behavioral counseling and programs including group treatment are effective is also consistent with the current evidence-based data.16,17
Some of the reported physician beliefs were not supported by experimental or clinical data. Physicians in this study believed the patch to be the most effective form of nicotine medication. Data comparing effectiveness of nicotine medications actually show similar effectiveness among various forms, with the nasal spray and inhaler having nonstatistical significantly higher abstinence rates than the patch.1,11
Interestingly, these two medications were perceived to be least effective.
Effectiveness of Selected Tobacco Dependence Treatments
There are many factors potentially influencing physician beliefs, including pharmaceutical industry activities, prescription versus over-the-counter (OTC) status of medications, and familiarity/experience with the treatments. As is its purpose, pharmaceutical marketing may influence a medication’s perceived effectiveness among physicians. For this reason, physicians may perceive marketed prescription medications as more effective than OTC medications and this may partially explain the results that bupropion was perceived as more effective. However, prescription status alone does not translate into perceived effectiveness. Because the nicotine inhaler and nasal spray comprise only a small proportion of cessation medications used (inhaler, spray, and lozenge combined were used by 3.7% of smokers who recently quit18
), most physicians have had little exposure to these medications despite their prescription status. The familiarity with the patch by physicians is much greater than that for the inhaler or nasal spray, possibly contributing to the belief that the patch is superior.
The low perceived effectiveness for telephone and internet-based treatments are interesting and not supported by current research that suggests these are effective interventions.19,20–22
Telephone quitlines are expanding on a statewide and national level, as are internet-based tobacco interventions. If these modalities are to be fully implemented, it is important that physicians, who may recommend them to their patients, are aware of their true effectiveness. If this study’s findings are an indication, physicians currently do not have much belief in the effectiveness of these treatments, and thus may not utilize them.
Personal characteristics of physicians also seem to influence perceived effectiveness. Female physicians and those trained outside the United States indicated higher beliefs of effectiveness for several treatments. Female physicians have traditionally been more prevention-oriented in their clinical care, such as counseling for condom use23
and drug use and sexual behaviors.24
Therefore, they may be more willing to see tobacco interventions as potentially effective. The findings that non-U.S.-trained physicians believed that some counseling interventions had higher levels of effectiveness could be explained by their training being more focused on observation, interpersonal relationships, and history taking (the foundations of counseling) and less on technology. This has been suggested in previous studies that have found higher rates of preventive services among non-U.S.-trained physicians.25
The limitations of this study include a response rate of 60%. Although this figure is above the published average for physician surveys, it is not optimal. Self-reported beliefs should be adequately collected by an anonymous survey with no incentives for specific responses. Also, newer tobacco treatments have been developed since this study was conducted (e.g., lozenge and varenicline) and are thus not included.
Overall, more education may be useful for physicians, especially regarding benefits of prescription forms of nicotine medications and telephone and internet-based interventions. Because training seems to be related to higher perceived effectiveness for some of the interventions (group treatment, nasal spray, and combination medications), trainings could be a good start to increase knowledge. Settings could include U.S. medical schools (considering U.S.-trained respondents reported lower beliefs of effectiveness) and utilize specialized tobacco treatment trainings/continuing medical education that are being initiated in several states.