Monday, November 3, 2003

This presentation is part of : High Risk Behavior

Using a Stage-of-Change Stamp to Identify and Advise College Smokers in a Student Health Clinic

Frances J. Kelley, PhD, RN, FNP, School of Nursing & Health Studies, Georgetown University, Washington, DC, USA, Sue A. Thomas, PhD, RN, FAAN, School of Nursing, University of Maryland, Baltimore, MD, USA, and Erika Friedmann, PhD, Department of Health and Nutrition Sciences, Brooklyn College of CUNY, Brooklyn, NY, USA.
Learning Objective #1: Identify system approaches currently available to identify smokers in a primary care setting
Learning Objective #2: Describe the implementation of a vital signs and stage-of-change stamp to identify and advise college smokers in a student health clinic

Objective: To increase identification of students who smoke and to increase cessation advice by college health practitioners

Design: Utilized retrospective chart reviews to assess effectiveness of system changes related to tobacco use identification and advice documentation

Population, Sample, Setting: The study was conducted at a college student health clinic that supports a college population of 11,500 students. All undergraduate student medical charts were reviewed for visits in the year before and the year after stamp introduction

Methods: Baseline data for current tobacco use and smoking cessation advice was obtained from chart review . Staff were instructed to stamp each record, ask every student about tobacco use and to ask smokers about plans to quit smoking. Providers were given pocket-sized cards defining stages of change and suggested stage-specific strategies for advisement. A second chart review evaluated the effectiveness of a vital sign and smoking identification stamp to increase identification of smokers and smoking cessation advice.

Findings: Over 6000 records were reviewed each year. There was no significant increase in the identification of smokers after stamp initiation. There was a significant increase in the amount of smoking cessation advice given and documented.

Conclusions: Identification of smokers remains a challenge in student health clinics. Only 17.7% of the students were identified as smokers. This is lower than 1999 national student college smoking rates of 28.4% . Frequency of identification of smoking status did not differ after initiation of stamp. After system changes, frequency of documentation of advice increased although documentation of advice continued to be low.

Implications: Visits in student health clinics are symptom focused rather than well visits. Creative solutions are needed to increase smoking cessation advice with all encounters with primary care providers.

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