Background
: It is well known fact that smoking is hazardous and fatal to health. Recently, physician's counselling about smoking cessation is carried out sucessfully and its importance is emerging. If phsicians can easily identify the current smoking status of the patient, the frequency of counselling will increase dramatically. This study evaluated the effect of including smoking status as a vital sign on the frequency of physician discussions with patients about smoking and physicians advice to quit smoking. Its purpose is to utilize this to practical practice.

Methods : From September 1 to October 31 in 1995, we analyzed 99 first-visit male patients(over age 20) who finished questionnaires which is composed of 7 questions during visiting family practice clinic in Ewha Womans University Mokdong Hospital in Seoul. Simple institutional change in clinical practice involved training the nurse how to use progress notepaper with a vital sign stamp that included smoking status(current, former, of never) along with the traditional visit signs from October, 1 1995 to October, 31, 1995 and just the traditional vital sign(blood pressure, body temperature, pulse rate) from September, 1, 1995 to September, 30, 1995. The contents of the survey were questions about whether the patient smoked, whether the patient was asked about smoking status by a doctor and, for smokers, whether they were urged to quit smoking.

Results : From September 1, 1995 to September 30, 1995, 52 patients participated and from October 1, 1995 to October 31, 1995, 47 patients did and the current smokers were 30 and 34 patients respectively. After expansion of the vital signs, patients were much more likely to report inquiries about their smoking status on the day of a clinic visit(an increase from approximately 53.3% at baseline to 82.4% at intervention ; P<0.05). The vital sign intervention was associated with significant increase in the percentage of smokers who reported that their clinician advised them to quit smoking (from approximately 36.7% at baseline to 61.7% during the intervention ; P<0.05). Age, age at which smoking was started, the number of cigarettes currently being smoked daily and number of previous quit attempts were not statistically significant.

Conclusion : Expanding the vital signs to include smoking status was associated with a dramatic increase in the rate of identifying patients who smoke and of intervening to encourage and assist smoking cessation. This simple, low-cost intervention may effectively prompt family physicians to inquire about use of tobacco and offer recommendations to smokers.