Clinician compliance with primary prevention of tobacco use: the impact of social contingencies.

Abstract

This study evaluated clinicians' compliance with delivering written advice and information against tobacco use (prevention prescriptions) to adolescent patients. Clinicians in 77 orthodontic offices were trained (and asked) to provide anti-tobacco counseling and prescriptions to 10- to 18-year-olds for 2 years. Each of eight prescriptions was provided for distribution to adolescent patients. Information concerning prescription-tracking methods and operant learning theory variables such as modeling and feedback was obtained using a cross-sectional interview of clinical staff. The proportion of prescriptions written was regressed on possible "determinants." Analyses were replicated for two time periods. Mean anti-tobacco prescription compliance was 66 and 73% for two separate time periods. Multiple regression analyses were computed for the first (R = 0.45, F(7,63) = 2.29, P < 0.001) and second (R = 0.48, F(7,63) = 2.76, P < 0.001) time periods. Prescription tracking and praise from patients were significant correlates for the first time period; praise and modeling were significant for the second time period. Twenty and twenty-three percent, respectively, of the variance in office prescription rate was explained. Results suggest that compliance with primary prevention procedures may be influenced by feedback from patients, staff modeling, and formal office tracking information.