| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|---|
|
|
|
|||||||
|
|||||||||
a School of Community Health, Portland State University, Oregon
b Institute on Aging, Portland State University, Oregon
c Department of Psychiatry, Oregon Health & Science University, Portland
Mark S. Kaplan, School of Community Health, Portland State University, P.O. Box 751, Portland, OR 97207 E-mail: kaplanm{at}pdx.edu.
 |
Abstract |
|---|
 Top Abstract MethodsResultsDiscussionReferences |
|---|
Methods. We used data on a probability-based sample of community-dwelling elderly respondents (N = 13,363) from the Canadian 1996–1997 National Population Health Survey. Descriptive statistics were calculated, and multivariate logistic regression analysis was performed to examine the associations between current tobacco use and contact with health care practitioners controlling for potential confounders, especially sociodemographic characteristics, selected health conditions, self-reported health, body mass index, functional status, perceived social support, and psychological distress.
Results. Older adults without a regular physician (adjusted odds ratio [AOR], 1.33; 95% confidence interval [CI], 1.11–1.59), with infrequent physical (AOR, 1.22; 95% CI, 1.07–1.40), and dental (AOR, 2.68; 95% CI, 2.07–3.47) checkups were more likely to be current smokers. Age (younger), church attendance (infrequent), drinking behavior (former or occasional), body mass index (normal weight), and psychological distress were all independently related to current smoking.
Conclusions. Results indicate that patients' contact with health care providers is strongly negatively associated with smoking. More specific data are needed to learn the frequency with which physicians and dental professionals attempt to modify older individuals' smoking behavior and the degree to which such efforts are effective.
"It's the only pleasure Grandpa has got left, so why not leave him alone?" (1)
APPROXIMATELY 12% of the North American population aged 65 and older smoke cigarettes daily (2)(3)(4). As baby boomers age, the number of older smokers is likely to continue to rise (5). Because most tobacco-related mortality occurs among older adults, the impact of smoking in this population and the potential benefits of cessation are large (6). According to Khaw, "tobacco smoking must be the single most preventable cause of ill health and disability; the benefits of not smoking in terms of respiratory function and cardiovascular disease are apparent even at older ages" (7). Indeed, elderly smokers who quit can gain significant health benefits and reduce their risk of death (8).
Late-life smokers represent an important population for intervention by health practitioners. Physicians (9)(10) and dentists (11) are in a prime position to play a role in smoking-cessation activities. In fact, older smokers are likely to see physicians more frequently than are younger groups (5). Moreover, up to 70% of adult smokers see their dentists each year (12). As a result, the practice guidelines of the United States Public Health Service recommend that clinicians identify smokers and encourage cessation as a routine part of virtually all health care providers' contacts (13).
In spite of the opportunities to do so, critics have argued that dentists and physicians continue to miss opportunities to provide advice on smoking cessation (14)(15)(16). Therefore, the purpose of this report was to determine the extent to which contact with health care providers correlates with smoking behavior in the elderly population. Such evidence will contribute to the development of more targeted clinical and public health interventions to reduce late-life smoking.
|
Methods |
|---|
|
TopAbstractMethodsResultsDiscussionReferences |
|---|
The dependent variable was "current smoking," and the independent variables of interest were three variables measuring contact with a physician ("Do you have a regular medical doctor?" and "When was the last time you had a physical checkup?") and a dentist ("When was the last time you went to a dentist?"). NPHS respondents were asked: "At the present time do you smoke cigarettes daily, occasionally, or not at all?" Current smoking was "daily" or "occasionally." To be consistent with recommendations for medical and dental checkups, we defined those who reported a physical checkup in less than the previous 2 years and those who reported a dental visit within the last year.
Control variables, identified in previous research as risk factors for tobacco use, included gender; age (5-year groupings); education (less than secondary, secondary, some postsecondary, and postsecondary); marital status; living arrangements (living alone vs other); smoking status (never or former vs current); alcohol use (abstainers, former, occasional, regular); chronic conditions (the sum of indicators for 13 specific conditions, including asthma, arthritis or rheumatism, back problems, high blood pressure, chronic bronchitis or emphysema, diabetes, heart disease, effects of a stroke, bowel disorder, Alzheimer's disease, cataracts, or glaucoma); physical activity (physical activity at least three times per week vs less activity); body mass index (BMI); functional limitations (need for help with instrumental or basic activities of daily living vs no need); frequency of church attendance; perceived social support; and nonspecific psychological distress.
Social support was measured with four items that reflect whether the respondents felt that they had someone they could confide in, someone they could count on, someone who could give them advice, and someone who made them feel loved. The score is derived from the sum of all true responses (yes vs no) to the four items. Psychological distress was assessed by six items on a 5-point Likert scale, ranging from "all of the time" to "none of the time." The participants indicated the frequency in the past month with which they had felt "so sad that nothing could cheer [them] up," "nervous," "restless or fidgety," "hopeless," "worthless," or that "everything was an effort" (19).
All independent variables were entered into the logistic regression model simultaneously. The effect of a predictor was thereby calculated after controlling statistically for all the others (20). The analyses were weighted to reflect the sample design, adjustments for nonresponse, and poststratification with variance estimates computed using SUDAAN (release 7.5.4; Research Triangle Institute, Research Triangle Park, NC).
|
Results |
|---|
|
TopAbstractMethodsResultsDiscussionReferences |
|---|
|
|
Discussion |
|---|
|
TopAbstractMethodsResultsDiscussionReferences |
|---|
The findings provide new information about factors associated with smoking by older adults that have policy and practice implications for physicians and other health care providers. The results suggest that older adults' contacts with physicians and dentists are strongly negatively associated with smoking among older adults. Having a regular physician and seeing that physician recently seems to have an important association with whether or not an older patient is a current smoker. It is also interesting that dental visits had an important relationship to smoking practice. Older adults who had not seen a dentist in the past year were nearly three times more likely to be current smokers.
These findings may guide future research and practice involving dentists and physicians discussing smoking with elderly patients (21). Although physicians have a unique opportunity to intervene when their patients need help to quit smoking, fewer than half (49.4%) ask their patients about tobacco use (22). Moreover, a recent survey of tobacco assessment and intervention practices showed that while dentists are more likely than physicians and other health professionals to estimate their patients' tobacco use accurately, they were less likely to assess and intervene, less supportive of tobacco cessation, less likely to report having strong tobacco-cessation skills and knowledge, and more likely to perceive barriers to tobacco intervention (23)(24). Given the frequency of dental care among older smokers, communication and cooperation between physicians and dentists are of crucial importance with respect to the management of late-life smoking.
Although the data suggest that contact with physicians and other health professionals may reduce smoking rates, these findings are not without limitations. Because the study was cross-sectional and not on an experimental trial, we cannot conclude that the physician and dental contacts were causes of reduced smoking rates in this population. Older adults with healthy behaviors may be both less likely to smoke and more likely to see a health care professional, although a wide range of personal characteristics were controlled in this study. In addition, more specific data are needed to learn the frequency with which physicians and dental professionals attempt to modify older individuals' smoking behavior and the degree to which such efforts are effective.
Our findings may have important clinical implications for health professionals who care for elderly smokers. If dental contact can affect smoking behavior, tobacco-use behavior modification strategies in dental school curricula and continuing education regarding tobacco (24) may be an important route to smoking cessation. Moreover, because most elderly smokers in our study had not visited a dentist in more than 5 years, periodontal preventive care appears to be much needed among this group. Primary care providers should remain alert to periodontal disease as well as other serious but less common oral diseases in older smokers and refer even their edentulous patients to dental professionals (25). Clearly, more studies of tobacco control interventions for older smokers are necessary.
|
Acknowledgments |
|---|
Received January 3, 2002
Accepted January 4, 2002
|
References |
|---|
|
TopAbstractMethodsResultsDiscussionReferences |
|---|
This article has been cited by other articles:
|
|
 |
|
  J. E. Morley and J. H. Flaherty Editorial It's Never Too Late: Health Promotion and Illness Prevention in Older Persons J. Gerontol. A Biol. Sci. Med. Sci., June 1, 2002; 57(6): M338 - 342. [Full Text]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|---|
| All GSA journals | The Gerontologist |
| Journals of Gerontology Series B: Psychological Sciences and Social Sciences | |
