Dspace2.flinders.edu.au
Archived at the Flinders Academic Commons:
http://dspace.flinders.edu.au/dspace/
This is the publisher's copyrighted version of this article.
The original can be found at: http://www.publish.csiro.au/?act=view_file&file_id=PY06054.pdf
2006 Australian Journal of Primary Health Care
Published version of the paper reproduced here in accordance with the copyright policy of the
publisher. Personal use of this material is permitted. However, permission to reprint/republish
this material for advertising or promotional purposes or for creating new collective works for
resale or redistribution to servers or lists, or to reuse any copyrighted component of this work in
other works must be obtained from Australian Journal of Primary Health Care.
GPs' Confidence in and Barriers to Implementing Smoking Cessation
Activities: Compared to Dentists, Dental Hygienists and Pharmacists
David Edwards,1 Toby Freeman,2 John Litt3 and Ann M Roche4
Quality Use of Medicines and Pharmacy research Centre, University of South
Australia, and Quit SA, Cancer Council South Australia1
National Centre for Education and Training on Addiction and School of Psychology
Flinders University,2 department of General Practice, Flinders University3
National Centre for Education and Training on Addiction and School of Medicine,
GP smoking cessation interventions have been found to be highly efficacious. However, reported uptake is low, and little is known about barriers or comparisons with other health professionals. The objectives of this study were to examine GPs' provision of smoking cessation activities, confidence and perceived barriers, and compare the results to other health professions (dentists, dental hygienists and pharmacists). A random sample of South Australian GPs (n = 69) were surveyed. Comparisons were made with dentists, dental hygienists and pharmacists for whom similar data had been obtained. Participants were surveyed on their confidence, perceived barriers, level of smoking cessation activity and practice and demographic factors. GPs reported greater provision of and greater confidence in a range of brief smoking cessation interventions than other professions and perceived fewer barriers to the provision of smoking cessation activities. Confidence and system barriers were reported as the most common factors that impeded greater provision of smoking cessation activities. It was concluded that confidence and system barriers need to be addressed to increase rates of smoking cessation interventions provided by these professional groups. Skills-based training that develops confidence would be beneficial for all health professional groups and would increase the number of smokers receiving advice and assistance to quit smoking.
Key words: Smoking, Tobacco, Prevention, Physicians
Tobacco is a leading cause of disease and death
concerning smoking from GPs (Richmond, Kehoe,
worldwide (Esson & Leeder, 2004). There is wide
Heather, Wodak, & Webster, 1996) and perceive
scope for the prevention of tobacco-related harm,
higher quality of care when the GP does address
and developing strategies to reduce harm is one of
smoking (Kottke, Solberg, Brekke, Cabrera, &
the most important goals for public health. Greater
Marquez, 1997).
provision of consistent advice about smoking
International clinical practice recommendations
cessation across all health care providers would
provide an evidence-based framework for smoking
considerably reduce tobacco-related harm.
cessation in health care settings. The framework consists of the "5 As"; Asking about smoking,
Smoking cessation interventions in the
Assessing dependence and readiness to change,
health care setting
Advising, Assisting in quitting, and Arranging
The efficacy of health professional interventions for
referral or follow-up (Zwar et al., 2004).
smoking cessation is well established (Lancaster &
However, uptake of smoking cessation activities
Stead, 2004). Spending less than three minutes with
among GPs in Australia has been poor, and has not
a smoker can double the chance of a successful
improved over the last decade (Humair & Ward,
attempt to quit (Zwar et al., 2004).
1998; Litt, 2002). Humair and Ward videotaped GP
Efforts to implement interventions in health
consultations and observed that GPs identified and
care settings have most often targeted GPs
intervened with less than a third of smokers, and
(Roche & Freeman, 2004). GPs are influential and
spent less than one minute, on average, discussing
credible (Pieterse, Seydel, DeVries, Mudde, & Kok,
smoking. In a survey of 1000 smokers attending
2001), patients are comfortable receiving advice
GPs, only 18% of smokers had ever been handed
Australian Journal of Primary Health — Vol. 12, No. 3, December 2006
David Edwards, Toby Freeman, John Litt and Ann M Roche
a Quit book by their GP and only 10% had been
and lack of skills. Smoking cessation activities
referred to the Quitline (Litt, Pilotto et al., 2003).
were compared among physicians, dentists,
Research has indicated that several barriers
dental hygienists, mental health counsellors and
have hindered the uptake of smoking cessation
counsellors on a specific program (Secker-Walker,
interventions in general practice. System-level
Chir, Solomon, Flynn, & Dana, 1994). Physicians
barriers include lack of time (Gottlieb, Guo, Blozis,
reported considerably higher rates of intervening,
& Huang, 2001; Wiggers, Sanson-Fisher, & Ring,
advising and assisting patients than the other
1997), difficulty identifying smokers (Gottlieb et al.;
professions. In a survey of smokers in the general
Wiggers et al.), lack of support (Litt, Ling, & McAvoy,
population, Tomar, Husten and Manley (1996)
2003; Young & Ward, 2001) and lack of incentives
found that smokers reported receiving advice to
(Pieterse et al., 2001; Young & Ward). Practitioner
quit smoking from physicians twice as often as
barriers include lack of interest (McAvoy, Kaner,
compared to dentists.
Lock, Heather, & Gilvarry, 1999; Young & Ward), lack of skills and training (McIlvain, Backer,
The current study
Crabtree, & Lacy, 2002), and negative attitudes
Very little is known about current comparative
towards smoking cessation interventions (McIlvain
rates of advice and assistance between health
et al.; Wigger et al.). Patient barriers include the
professions and differences in perceived barriers
patient not being interested in quitting (Coleman
and confidence. This study was designed to
& Wilson, 1999), and infrequently requesting help
address that gap. Smoking cessation activities
(Borland, Pigott, Rintoul, Shore, & Young, 2002).
amongst GPs—their level of confidence, readiness
After several decades of concerted effort to
to change smoking cessation activities and
engage GPs in smoking cessation interventions,
perceived barriers—were examined. The impact
discouraging levels of involvement have prompted
of confidence and barriers on smoking cessation
examination of possible additional intervention
activity was also examined. These results were
agents. All health professions could potentially play
compared to three other professional groups
a role in addressing smoking amongst their patients
(dentists, dental hygienists and pharmacists) for
through offering advice and support to quit smoking
whom similar data had also been obtained.
(Ministerial Council on Drug Strategy, 2004). Upskilling other health professionals in smoking
cessation in addition to GPs has several benefits.
Participants and procedures
Firstly, the more professions that routinely deliver
The questionnaire was mailed to all 590 general
smoking cessation interventions, the wider the
practitioners registered in South Australia with the
population of smokers who will receive assistance
Royal Australian College of General Practitioners
from at least one health professional. Secondly,
(SA Branch). Only participants working at least
other professionals may not experience as many
two sessions per week were included to ensure
barriers to implementation as GPs, and hence may
responses reflected current general practice
be able to achieve greater rates of uptake (Roche &
Freeman, 2004). Thirdly, if multiple delivery agents
After three weeks a reminder postcard was
are employed, smokers may receive consistent
sent to non-respondents. A second copy of the
quit smoking messages from more than one health
questionnaire and letter of endorsement was
professional, which may increase the motivating
sent a further two weeks later. Three weeks after
effects of the advice.
the second mail-out a random sample of non-
Few studies have undertaken cross-disciplinary
respondents were telephoned (
n = 153).
examinations of smoking cessation activities. The little data available comparing uptake or
barriers between professions come mainly from
The activity, barriers and readiness to change scales
the United States. Perez-Stable et al.(2001) found
were adapted from measures developed for the
that physicians were more likely to intervene with
GASP program (Litt et al., 2005). The following
smoking parents than paediatricians, who were
measures were included:
more likely to perceive barriers to smoking cessation
Background variables – variables measured
activities, including poor patient receptiveness
included personal characteristics (age, gender,
Australian Journal of Primary Health — Vol. 12, No. 3, December 2006
GPs' Confidence in and Barriers to Implementing Smoking Cessation Activities: Compared to Dentists, Dental Hygienists and Pharmacists
smoking status, smoking cessation education or
Five items measured practitioner barriers
training) and practice characteristics (solo or group
addressing personal factors such as "Lack
practice, consulting hours per week, number of
of necessary skills to assist patients to quit"
patients seen in the last week, average consultation
(Cronbach's alpha .72).
length, display of Quit materials).
Four items measured patient barriers addressing
Confidence – confidence was defined as
the management of patients or patients' attitudes
health professionals' self-efficacy beliefs regarding
(Cronbach's alpha .81). An example item is
smoking cessation activity. Eight items assessed
"Patients don't want to discuss quitting".
confidence in undertaking different aspects of
The same questionnaire (modified slightly to suit
smoking cessation interventions (see Table 5,
specific health professional groups) was distributed
response scale: 1 "Not confident" to 5 "Extremely
simultaneously to all dentists (
N = 621), dental
confident"). Internal consistency was high
hygienists (
N = 70) and pharmacists (
N = 691)
(Cronbach's alpha: .80).
registered in South Australia during the same time
Readiness to change – Participants were asked to
period. The administration of the questionnaire was
select one of three options: that they didn't see a need
identical and all measures were comparable across
to change the way they provided smoking cessation
professional groups. Measures of confidence,
services, that they were seriously thinking about
readiness to change, and system, practitioner
changing in the next six months or that they had
and patient barriers, and most items measuring
already initiated changes in the last six months.
activity were the same across professional groups,
Smoking cessation activity – six scales addressed
with the exception of minor wording changes to
smoking cessation activity based on the 5As and
reflect the setting. Some activity items concerning
an additional measure of follow-up activity. A
nicotine replacement therapies, Zyban, linking the
5-point Likert scale was used (1 "Never" to 5
advice to the presenting problem and referring
"Always"). Recording smoking status was measured
to the Quitline were modified slightly for some
with one item, "Record smoking status on file".
professions to reflect issues such as ability to
Recording smoking status was chosen rather than
prescribe and other professional factors.
asking about smoking as it is a more concrete behaviour. Advising was measured by three items:
giving brief advice to quit, linking advice to the
Demographic factors were compared between
presenting problem, and discussing the effects of
GPs, dentists, dental hygienists and pharmacists,
smoking on other family members (Cronbach's
and between the current sample of GPs and
alpha .70). Assessing was measured using two
national labour force estimates (Britt et al., 2004)
items, "Assess interest in quitting" and "Assess the
using chi-squared and t-tests. Confidence, barriers
level of nicotine dependence" (Cronbach's alpha
and smoking cessation activities were compared
.53). Assisting the patient to quit smoking was
between professions using t-tests. Relationships
measured by six items addressing strategies such
between these variables were examined using
as setting a quit date, developing a cessation plan
standard multiple regression analyses on a
and providing Quit materials (Cronbach's alpha
combined measure of activity (calculated from
.68). Arranging was measured using four items
the mean of all activity items, Cronbach's alpha
addressing referrals to the Quitline or a Quitline
0.87 for GPs). To include readiness to change as
program and recommending nicotine replacement
a dichotomous variable in the regression analysis,
therapy or Zyban (Cronbach's alpha .54). Follow-
the responses "seriously thinking" and "already
up was measured with one item, "Follow-up on
initiated" were combined.
progress in giving up smoking".
Barriers to providing smoking cessation
activities – 17 items assessed system, practitioner and patient barriers to service provision. The
The total number of respondents was 269 general
perceived importance of each barrier was assessed
practitioners. In 18 cases the questionnaire was not
on a 5-point Likert scale (1 "Not a barrier at all" to
completed; two had retired, seven were no longer
5 "A major barrier"). Eight items measured system
practising and nine questionnaires were returned
barriers (see Table 5, Cronbach's alpha .87).
"not completed" or "not at this address", resulting
Australian Journal of Primary Health — Vol. 12, No. 3, December 2006
David Edwards, Toby Freeman, John Litt and Ann M Roche
in a final response rate of 47%.
in a solo practice, equivalent to the national labour
Response rates for the comparator groups were:
force estimate (Britt et al., 2004) (11%) (c2(1,
n =
dentists 54% (
N = 334), dental hygienists 83% (
N
1,252) = 0.47,
p = 0.49) and 238 (89%) worked in
= 58) and pharmacists 48% (
N = 331). Dentists
a team with more than one general practitioner.
and dental hygienists were representative of the
Five respondents were locums.
national population in terms of gender and public
Just over half of general practitioners employed
or private sector. Dentists were younger than the
a practice nurse (
n = 156, 59%), equivalent to the
national sample and worked fewer hours per
national labour force estimate (Britt et al., 2004)
week. Dental hygienists were representative of the
(58%) (c2(1,
N = 1,262) = 0.01,
p = 0.92).
national sample on age, but also worked fewer
GPs in the current sample were younger than
hours per week. Pharmacists were representative
the national (Britt et al., 2004) average (c2(3,
n =
of the national population in hours worked
1,265) = 71.49,
p < .001), 57% were aged 44 years or
per week, but were younger than the national
less. GPs in the current sample worked fewer hours per week compared to the national labour force
population; female pharmacists were slightly
estimate (Britt et al.) (c2(3, n = 1,234) = 35.65, p <
.001), 71% worked 40 hours or less per week.
Means and standard deviations for demographic
variables by profession are shown in Table 1. GPs
Of the 269 general practitioners, 159 (59%) were
saw two to four times as many patients per week
male and 109 (41%) were female, significantly
than either dentists or dental hygienists. This was
different to the national labour force estimate (Britt
not measurable for pharmacists. Conversely, GPs
et al., 2004) (c2(1,
N = 1,268) = 5.95,
p = .015),
had the shortest consultation time, less than half
which comprises 67% males (46).
that of dentists, and less than a third of the time
The majority of general practitioners had
hygienists spent with each patient.
never smoked (77%,
n = 207). Only six (2%) were current smokers—well below the national
Smoking cessation activities and barriers
prevalence rate of 17% (Australian Institute of
Means and standard deviations for confidence,
Health and Welfare, 2005).
barriers and smoking cessation activities by
Twenty-four general practitioners (9%) worked
profession are shown in Table 1. GPs reported
Table 1: Means (and standard deviations) for demographic variables, confidence, activities and barriers by profession
Variable (Number of items)
GPs (
N = 269)
Dentists (
N = 334)
Hygienists (
N = 58)
Pharmacists (
N = 265) F
Years in practice
Patients per week
Hours worked /week
Consult length (mins)
System barriers (8)
Prof. barriers (5)
Patient barriers (4)
Note: N/A = Not applicable (not asked in the questionnaire). Means with the same alphabetical subscript were not significantly different using Tukey's HSD test. All ANOVA results remained significant after Bonferroni adjustment for multiple testing.
*** p
< .001
Australian Journal of Primary Health — Vol. 12, No. 3, December 2006
GPs' Confidence in and Barriers to Implementing Smoking Cessation Activities: Compared to Dentists, Dental Hygienists and Pharmacists
Table 2: Education or training in smoking cessation and levels of readiness to change by profession
GPs (
N = 269)
Dentists (
N = 334) Hygienists (
N = 58)
Pharmacists (
N = 265) c2(
df=3)
Smoking cessation education/training
No need to change practice
Seriously thinking about change
Already initiated change
Note: Means with the same alphabetical subscript were not significantly different using post hoc Bonferroni adjusted pairwise comparisons.
*** p
< .001
the highest level of confidence and lowest level
on the activity scale. None of the factors was
of barriers relative to the other three health
significant; hence, they were excluded from the
professional groups.
main analysis.
GPs had the highest overall activity followed
The standardised (b) and unstandardised (B)
by pharmacists and dental hygienists, with dentists
regression coefficients for the main regression
reporting the least activity. GPs and dental hygienists
analysis are presented in Table 3. Confidence
were the most active recorders of smoking status,
emerged as the most important predictor of
GPs and pharmacists were the most active health
smoking cessation activities, followed by system
professionals in assessing nicotine dependence
barriers. Overall, the variables accounted for 33%
and readiness to quit, and GPs were most active
of variance in the smoking cessation activities.
in advising and following up on patient progress
The standardised (b) and unstandardised (B)
with quitting. Pharmacists were the most active
regression coefficients for the most important
group in regard to arranging referrals.
predictors of smoking cessation activity across the
GPs indicated high levels of readiness to change
four professional groups are presented in Table
their smoking cessation activities (see Table 2
4. Confidence emerged as the most important
below). Fewer GPs saw no need to change their
predictor of smoking cessation activity across all
current practice compared to dentists, and more
Table 3: Multiple regression analysis for the smoking
GPs had already initiated changes to their provision
cessation activities of GPs
of smoking cessation activities compared to dentists
and pharmacists.
More GPs had received smoking cessation
education or training (32%) compared to the other
professions. Dentists reported the least education
Education or training
and training and the least interest in changing their
Readiness to change
provision of smoking cessation activities.
Standard multiple regression analyses were
run on the combined activity measure. Practice
Practitioner barriers
factors, including whether it was a solo or group
practice, consulting hours per week, patients
Note: B are unstandardised coefficients, b
are standardised
per week, consultation length and whether the
practice employed a practice nurse, were regressed
* p
< .05, ** p
< .01, *** p
< .001
Table 4: Comparison of multiple regression analysis results for the smoking cessation activities of GPs, dentists,
dental hygienists and pharmacists
GPs (
N =269)
Dentists (
N = 334)
Hygienists (
N = 58)
Pharmacists (
N = 265)
a approached significance (p
=.056) b approached significance (p
=.09)Note: B are unstandardised coefficients, b
are standardised coefficients.
Australian Journal of Primary Health — Vol. 12, No. 3, December 2006
David Edwards, Toby Freeman, John Litt and Ann M Roche
Table 5: Mean ratings of importance (and standard deviations) of confidence and system barriers for GPs
Confidence (5 = extremely confident)
Raise smoking issues when they are related to the visit
Discuss patient readiness to change smoking behaviour
Use brief advice to help people quit
Assess nicotine dependence and recommend therapies
Raise smoking issues when not related to the visit
Spend additional time assisting patients who are having difficulties with the quitting process
Increase patient motivation to quit using specific counselling strategies
Engage all staff members in a process to develop systems for smoking cessation.
System barriers (5 = a major barrier )
Insufficient financial incentives for time spent
No coordinated plan to implement protocols/guidelines
Lack of feedback on patient progress
Lack of smoking cessation protocols/guidelines
Lack of knowledge of other support services
Lack of printed resources
Lack of reminders of patient smoking status
Note: All items were measured using a 5-point Likert scale ranging from 1 ("Not confident"/"Not a barrier") to 5 ("Extremely confident"/"A major barrier").
groups. Practitioner factors were significant for
improve confidence levels. Education and training
dentists and dental hygienists, and approached
alone is not sufficient; Richmond, Mendelsohn
significance for pharmacists, while system barriers
and Kehoe (1998) found that lack of confidence
were significant for dentists and general practitioners
was still quite low following training in effective
and approached significance for dental hygienists.
behavioural techniques to assist smokers.
GPs' confidence and system barriers were
GPs are ahead of other health professional
analysed to identify the specific issues perceived
groups in terms of uptake of smoking cessation
to be of highest importance (see Table 5). General
activities. There may be several reasons for this,
practitioners were least confident about engaging
including GPs' higher rate of smoking cessation
staff members in a process to develop systems
education and training compared to the other
for smoking cessation and increasing patient
professions surveyed, and arguably having greater
motivation using specific counselling strategies.
resources to draw upon (such as being able
The practitioner barriers perceived to be most
to prescribe Zyban) and greater knowledge of
important were lack of time and lack of financial
potential co-morbidities and health effects. GPs
incentives for spending time on smoking.
also reported fewer barriers to activity. However, many smokers are still not receiving smoking
cessation advice and assistance from their GP (Humair & Ward, 1998; Litt, Pilotto et al., 2003).
This study is the first Australian research to (1)
There is still room to improve uptake of smoking
compare GPs' self-reported smoking cessation
cessation interventions. In particular, the more
activities to other professional groups, namely
proactive strategies of assisting patients to quit and
dentists, dental hygienists and pharmacists, and
arranging referrals to services such as a quitline
(2) compare confidence in and barriers to smoking
are under-utilised. Given the effectiveness of quit
cessation activities among these professions.
lines for smokers (Stead, Lancaster, & Perera, 2004),
Confidence emerged as the major predictor of
interventions with GPs should focus attention on
provision of smoking cessation activities to patients
these strategies in order to maximise the impact
across all professions. If confidence is a pivotal
GPs could have on smoking cessation rates among
factor, then questions arise regarding how to
their patients.
Australian Journal of Primary Health — Vol. 12, No. 3, December 2006
GPs' Confidence in and Barriers to Implementing Smoking Cessation Activities: Compared to Dentists, Dental Hygienists and Pharmacists
The system barrier rated as most important
Limitations of the study
by GPs was lack of time to discuss smoking.
While the GP sample in the present study matched
Strategies that address or acknowledge the limited
national labour force estimates on variables
opportunistic time available to GPs (Jaen et al.,
such as solo or group practice, and employing a
2001) and reflect the current time they devote to
practice nurse, the current sample were younger,
smoking cessation (Humair & Ward, 1998) are
worked fewer hours per week and had a higher
more likely to be acceptable and adopted (Jaen
proportion of females than the national estimate
et al., 2001; Litt, 2002).
(Britt et al., 2004). These differences, in addition
GP implementation of effective smoking
to the low response rate for GPs, suggest that the
cessation activities could be improved by:
current sample may represent those GPs most likely to intervene with their smoking patients.
• improved smoking cessation training and
Consequently, findings from this sample should
education (Lancaster, Silagy, & Fowler, 2004)
best be viewed as "as good as it gets" for GPs'
• clinical systems that provide a supportive practice
smoking cessation activities.
infrastructure (McIlvain et al., 2002)
While the current findings are applicable to
South Australia and may be applicable to other
• developing and implementing organisational
Australian states and territories, similar research
policies that are conducive to smoking cessation
is needed internationally to examine global
activity (Litt, Ling, & McAvoy, 2003).
similarities and differences. Although Pieterse et al. (2001) suggest that barriers to uptake of
smoking cessation interventions among GPs may
The majority of GPs, dental professionals and
be universal, there is not a strong evidence base
pharmacists reported willingness to engage in
to support this, and it is likely that variation in
smoking cessation activities. Hence, there is
systemic barriers exists between countries.
opportunity to increase levels of smoking cessation
The general criticism of self-reported measures
activity. Increasing the range of health professionals
of behaviour applies—that participants' reported
skilled and prepared to respond to smoking would
levels of behaviour may not equate to real
increase the chances of every smoker receiving
behaviour. Previous evidence suggests that GPs
advice and assistance to quit smoking from a health
tend to over-report their prevention activities
(Wilson & McDonald, 1994). However, this can
In order to achieve increased participation of
only be addressed through the observation of
health professionals in smoking cessation activities,
participants' behaviour, which presents many challenges and is beyond the scope of this research.
the key barriers identified in this study need to be
The self-report measures used in this study are not
addressed—in particular levels of confidence.
established scales, but rather were adapted from
A key strategy to increase confidence and
the GASP program (Litt, Pilotto et al., 2005). Hence,
skills among health workers is the provision of
internal consistencies were the only psychometrics
education and training. Less than one-third of the
available, and these are not necessarily appropriate
South Australian GPs indicated they had received
for judging reliability. Since the activity measures
education and training in smoking cessation,
are indexes of different behaviours, rather than
and rates were even lower among the other
scales, participant responses are not expected to
professions. This is a serious deficit that must be
be homogenous across items (Streiner, 2003). What
Cronbach's alphas may be indicating in this case
This study demonstrates that many of the issues
is that GPs use different assessing and arranging
which affect health workers' smoking cessation
strategies to different degrees (moderate alphas),
activities are common across professional groups.
where their use of advising and assisting strategies
Hence, there may be benefits in adopting a
are more uniform (high alphas). Future research
systematic and coordinated approach that addresses
may be able to build on the current findings by
common issues across professional boundaries, as
developing validated instruments and examining
in the Clinical Tobacco Intervention Program based
possible methods of ascertaining estimates of actual
in Ontario, Canada (www.ctica.org).
Australian Journal of Primary Health — Vol. 12, No. 3, December 2006
David Edwards, Toby Freeman, John Litt and Ann M Roche
prevention strategy. If the deficits identified by this study were addressed, the contribution GPs
Increasing the consistency of provision of smoking
and other health professionals could make to the
cessation advice across health providers would
prevention of smoking-related harm would be
maximise the public health benefits of this essential
references
Australian Institute of Health and Welfare. (2005). 2
00 National Drug Strategy Household Survey: First results. AIHW cat. no. PHE
7. Canberra: AIHW (Drug Statistics Series No. 13).
Borland, R., Pigott, R., Rintoul, D., Shore, S., & Young, S. (2002).
Barriers to access of smoking cessation programs, nicotine
replacement therapy and other pharmacotherapies for the general Australian population and at risk population groups. Final report. Canberra: Commonwealth Department of Health and Ageing.
Britt, H., Miller, G. C., Knox, S., Charles, J., Valenti, L., Pan, Y., et al. (2004).
General practice activity in Australia 00-0. AIHW
Cat. No. GEP 16. Canberra: Australian Institute of Health and Welfare.
Coleman, T., & Wilson, A. (1999). Factors associated with the provision of anti-smoking advice by general practitioners.
British
Journal of General Practice, 9, 557-558.
Esson, K. M., & Leeder, S. R. (2004).
The Millennium development goals and tobacco control: An opportunity for global partnership.
Geneva: World Health Organization.
Gottlieb, N. H., Guo, J. L., Blozis, S. A., & Huang, P. P. (2001). Individual and contextual factors related to family residents'
assessment and counseling for tobacco cessation.
Journal of the American Board of Family Practice, 1, 343-351.
Humair, J. P., & Ward, J. (1998). Smoking-cessation strategies observed in videotaped general practice consultations.
American
Journal of Preventive Medicine, 1, 1-8.
Jaen, C. R., McIlvain, H., Pol, L., Phillips, R. L., Flocke, S., & Crabtree, B. F. (2001). Tailoring tobacco counselling to the competing
demands in the clinical encounter.
Journal of Family Practice, 0(10), 589-863.
Kottke, T. E., Solberg, L. I., Brekke, M. L., Cabrera, A., & Marquez, M. (1997). Will patient satisfaction set the preventive services
implementation agenda?
American Journal of Preventive Medicine, 1, 309-316.
Lancaster, T., Silagy, C., & Fowler, G. (2004). Training health professionals in smoking cessation (Cochrane review).
The Cochrane
Library Issue .
Lancaster, T., & Stead, L. F. (2004). Physician advice for smoking cessation.
The Cochrane Database of Systematic Reviews, Issue
. Art. No.: CD000165.pub2.
Litt, J. C. B. (2002). How to provide effective smoking cessation advice in less than a minute without offending the patient.
Australian Family Physician, 1, 1087-1094.
Litt, J. C. B., Ling, M. Y., & McAvoy, B. (2003). How to help your patients quit: Practice-based strategies for smoking cessation.
Asia Pacific Family Medicine, , 175-179.
Litt, J. C. B., Pilotto, L., Young, R., Ruffin, R., Wade, T., Edwards, D., et al. (2003).
GPs Assisting Smokers Program II: Effective
smoking cessation strategies – putting it in to practice. Paper presented at the 1st Australian Tobacco Control Conference, Melbourne.
Litt, J. C. B., Pilotto, L., Young , R., Ruffin , R., Wade, T., Grbich, C., et al. (2005). GPs
Assisting Smokers Program (GASP II): Report
for the six month post intervention period. Adelaide: Flinders University.
McAvoy, B., Kaner, E. F., Lock, C. A., Heather, N., & Gilvarry, E. (1999). Our healthier nation: Are general practitioners willing and
able to deliver? A survey of attitudes to and involvement in health promotion and lifestyle counselling.
British Journal of General Practice, 9, 187-190.
McIlvain, H. E., Backer, E. L., Crabtree, B. F., & Lacy, N. (2002). Physician attitudes and the use of office-based activities for tobacco
control.
Family Medicine, , 114-119.
Ministerial Council on Drug Strategy. (2004).
National Tobacco Strategy 00-009: The strategy. Canberra: Commonwealth of
Perez-Stable, E. J., Juarez-Reyes, M., Kaplan, C. P., Fuentes-Afflick, E., Gildengorin, V., & Millstein, S. G. (2001). Counseling smoking
parents of young children: Comparisons of pediatricians and family physicians.
Archives of Pediatrics and Adolescent Medicine, 155, 25-31.
Pieterse, M. E., Seydel, E. R., DeVries, H., Mudde, A. N., & Kok, G. J. (2001). Effectiveness of a minimal contact smoking cessation
program for Dutch general practitioners: A randomized controlled trial.
Preventive Medicine, , 182-190.
Richmond, R., Kehoe, L., Heather, N., Wodak, A., & Webster, I. (1996). General practitioners' promotion of health life styles: What
patients think.
Australian and New Zealand Journal of Public Health, 0, 195-200.
Richmond, R., Mendelsohn, C., & Kehoe, L. (1998). Family physicians' utilization of a brief smoking cessation program following
reinforcement contact after training: a randomised trial.
Preventive Medicine, 7, 77-83.
Roche, A. M., & Freeman, T. (2004). Brief interventions: Good in theory but weak in practice.
Drug and Alcohol Review, , 11-
Secker-Walker, R. H., Chir, B., Solomon, L. J., Flynn, B. S., & Dana, G. S. (1994). Comparisons of the smoking cessation counseling
activities of six types of health professionals.
Preventive Medicine, , 800-808.
Stead, L. F., Lancaster, T., & Perera, R. (2004). Telephone counselling for smoking cessation (Cochrane Review).
In: The Cochrane
Library, Issue , 00.
Streiner, D. L. (2003). Being inconsistent about consistency: When coefficient alpha does and doesn't matter.
Journal of Personality
Assessment, 80, 217-222.
Tomar, S. L., Husten, C. G., & Manley, M. W. (1996). Do dentists and physicians advise tobacco users to quit?
Journal of the
American Dental Association, 17, 259-265.
Australian Journal of Primary Health — Vol. 12, No. 3, December 2006
GPs' Confidence in and Barriers to Implementing Smoking Cessation Activities: Compared to Dentists, Dental Hygienists and Pharmacists
Wiggers, J., Sanson-Fisher, R., & Ring, I. (1997). Practitioner provision of preventive care in general practice consultations:
Association with patient, educational and occupational status.
Social Science and Medicine, , 137-146.
Wilson, A., & McDonald, P. (1994). Comparison of patient questionnaire, medical record and audio tape in assessment of health
promotion in general practice consultations.
British Medical Journal, 09, 1483-1485.
Young, J. M., & Ward, J. E. (2001). Implementing guidelines for smoking cessation: Advice in Australian general practice: Opinions,
current practices, readiness to change and perceived barriers.
Family Practice, 18, 14-20.
Zwar, N., Richmond, R., Borland, R., Stillman, S., Cunningham, M., & Litt, J. C. B. (2004). Smoking cessation guidelines for Australian
general practice. Canberra: Commonwealth Department of Health and Ageing.
David Edwards Quit SACancer Council South AustraliaPO Box 929Unley South Australia 5061 AUSTRALIAEmail:
[email protected]
Toby Freeman National Centre for Education and Training on AddictionSchool of PsychologyFlinders University GPO Box 2100Adelaide South Australia 5001AUSTRALIA
John Litt Department of General PracticeFlinders UniversityGPO Box 2100Adelaide South Australia 5001AUSTRALIA
Ann M Roche National Centre for Education and Training on AddictionFlinders University GPO Box 2100Adelaide South Australia 5001AUSTRALIA
Correspondence to David Edwards
Australian Journal of Primary Health — Vol. 12, No. 3, December 2006
cover sheet.pdf
Source: http://dspace2.flinders.edu.au/xmlui/bitstream/handle/2328/11531/2006002206.pdf?sequence=1
EDITORIAL Nuevamente tenemos el privilegio de poner AUTORIDADES DE LA UAP en las manos de nuestros lectores un nuevo número de Enfoques, con el objetivo de com- partir los aportes de prestigiosos investiga- dores y pensadores. Vicerrector Académico Milton Bentancor realiza una comparación Dr. Víctor Armenteros entre el relato de la Creación de los mayas-
The Brain and Fatigue : New Opportunities for Nutritional Romain Meeusen1, Phil Watson2 , Jiri Dvorak3 1. Dept Human Physiology & Sportsmedicine - Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels , Belgium 2. School of Sport and Exercise Sciences, Loughborough University, Leicestershire, LE11 3TU, 3. Dept Neurology and F-MARC (FIFA Medical Assesment and Research Center) Schulthess
|