Patients who smoke get little help from docs in stopping

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Most of the estimated 45 million Americans who still smoke say they'd like to quit.It may be harder for them than ever, though. Research presented this week during a meeting of the American College of Chest Physicians shows that nearly 75 percent of people seeking treatment for tobacco-dependence are highly addicted to nicotine.Scientists are regularly finding even more reasons for people to kick butts -- particularly if they're around kids.Just last month, Canadian researchers reported that children regularly exposed to second-hand smoke in homes and cars are more likely to experience nicotine dependence symptoms.Other recent studies show that ear infections and hospital admissions for all sorts of infectious diseases are more severe and more common in passive-smoking children.And a mouse study reported by Yale School of Medicine researchers in July showed that being exposed to the smoke of as few as two cigarettes a day experienced exaggerated levels of inflammation when exposed to cold and flu viruses.So there's plenty besides the Big C and heart attacks to motivate smokers to quit.Yet the medical system seems particularly ill equipped to tackle stop smoking efforts.Sure, almost all doctors will ask if you smoke when you come in for an office visit, but what happens next is far from consistent. Various studies over the years suggest maybe half do much more than note tobacco use on the patient's record.Research suggests that those who offer even a little advice on quitting -- a leaflet or a sample of nicotine gum -- increase the quit rate among their patients by 1 to 3 percent beyond the 2 or 3 percent who regularly try to quit unassisted.Of course, health plans that offer docs financial incentives to steer smokers to quit phone lines see results. One study, out this month in the Archives of Internal Medicine found that offices with incentives made 3 times more referrals than those with no financial stake.But the more fundamental problem is that most primary care docs simply don't get much training in treating addiction, nicotine or otherwise.Another report from the chest physicians meeting found that 87 percent of 322 doctors, physician assistants and nurse practitioners surveyed said they'd had less than 5 hours of tobacco dependence training and 94 percent were not familiar with government treatment guidelines for tobacco dependence.The survey also found that most of the medical professionals didn't know which drugs used as stop-smoking aids require a prescription or can be bought over-the-counter, nor were they familiar with possible drug interactions or other problems that might face patients using the drugs or going through nicotine withdrawal.Lack of training -- and lack of confidence -- may explain why so many doctors don't press patients harder to quit smoking, and are unlikely to try and manage the treatment themselves.But a small study done a few years back by researchers at the University of North Carolina-Chapel Hill shows that early hands-on stop smoking practice for doctors can help.A survey of 291 primary care docs found those who practiced smoking cessation methods while training as medical residents were twice as likely to still be using them more than 8 years later, compared to those who got similar instruction, but didn't use the skills regularly in their first years as a doctor.On the Net: http: //www.chestnet.org www.cancer.org (Distributed by Scripps Howard News Service, http://www.scrippsnews.com)