Karen M. Gil, PhD Susan Labuda Schrop, MS Sarah C. Kline, BS Emily A. Kimble, BS Gary McCord, MA Kenelm F. McCormick, MD Valerie J. Gilchrist, MD Rootstown, Ohio From the Office of Research and Sponsored Programs and the Departments of Behavioral Sciences (K.M.G.) and Family Medicine (S.L.S., G.M., K.F.M., V.J.G), Northeastern Ohio Universities College of Medicine (S.C.K., E.A.K.), Rootstown, OH. This article was presented previously as “Changing Health Behavior in Patients at Underserved Clinics” (poster presented at the Society of Teachers of Family Medicine, Patient Education Conference; November 2002; Albuquerque, NM) and “Decisional Balance in Smokers Seeking Medical Care at Clinics for the Underserved” (presented at the 19th Annual Meeting of the Society of Teachers of Family Medicine, Northeast Region; October 2000; Philadelphia, PA). The authors report no competing interests. Partial funding was provided by the Summer Research Fellowship Program, Northeastern Ohio Universities College of Medicine.
A variable that may contribute to high smoking rates in this population is the number of cigarettes smoked each day. Almost half (46%) of the people who claimed that they planned to quit within the near future were still smoking more than a pack each day. Heavier smokers in this study were more tempted to smoke when they were angry or frustrated and from habit. Level of addiction (which includes amount smoked each day) is a strong predictor of quit attempts.16 Perhaps the level of addiction should be addressed separately from willingness to quit smoking within this population. Pharmacologic aids or counseling in using other strategies to decrease smoking from frustration or habit may enable smokers to act on their decision to quit smoking and make smoking cessation attempts. Further advances in smoking cessation practices that are dependent on pharmacologic agents should take into account the ability of this population to obtain these aids.
A limitation of this study is the small geographic area represented. Further work should be conducted with other groups of medically underserved smokers (more rural and more urban populations) to determine whether these results can be generalized.
Research is currently being conducted on the degree to which tailored information enhances the effectiveness of smoking cessation advice.10,11,32 Federal guidelines focus on distinguishing between smokers who are and are not willing to quit,8 and they provide suggestions for counseling. However, identifying salient characteristics of subgroups that can be used to design information to increase smoking cessation has great appeal. Examples include reinforcing the negative consequences of smoking for people in the precontemplation stage, suggesting mechanisms other than smoking to cope with stress for people in the contemplation stage, providing concrete suggestions or pharmaceutical help for people in the preparation stage, and encouragement for people in the action stage. Part of the driving force for this research is the possibility that the information can be used in a variety of formats, including computer-generated tailored messages.33,34 Data from this study suggest that smokers attending clinics for the medically underserved are processing information about smoking in a manner similar to that of the general population. Although there may be some differences in the specific type of information that has relevance to this group, these smokers should be able to profit from research that identifies which processes are most effective in motivating subgroups defined by their willingness to consider quitting smoking. Smokers in this population may present with problems that require immediate and comprehensive management, but they should also be provided with preventive health care counseling.
