Senior onderzoeker Internationaal vergelijkend onderzoek (WHO)
Influence of public alcohol and tobacco use on general practitioners' advice: an international comparative study.
Pas, L., Boerma, W., Spreeuwenberg, P., Saunders, J.B., Zee, J. van der. Influence of public alcohol and tobacco use on general practitioners' advice: an international comparative study. European Journal of Public Health: 2002, 12(suppl. 4) 86-87. Abstract. 10th Annual Eupha Meeting 'Bridging the Gap between research and policy in public health: information, promotion and training', Dresden, Germany 28 - 30 November 2002.
Background: Efficacy of advice for substance use is proven in general practice. Studies show high variability of perfomance. Especially intercountry variability has rarely been taken into account. Aim: To study the influence of public tobacco and alcohol use and health service characteristics on the general practitioners' involvement in counselling for tobacco and alcohol use. Methods: A multilevel analysis was performed distinguishing general practice level (workload, assistance, gender and age) and country level (health service characteristics and substance use). Data for practice level were used form 3 survey studies: the task profile study (32 European countries; 1992); a collaborative action in 5 European countries (1996) and a WHO trial (14 countries world wide; 1997). Health services' characteristics were obtained form literature. From WHO and OECD databases consumption (mean litres of pure alcohol / person / year used; mean grams of tobacco consumed / person / year) and percent change were derived for 4-year periods. Dependant variable was self-estimated extend of asking about use.Results: Variations in asking attributed to country level ranged up to 13% for tobacco and to 15% for alcohol. Only small effects (estimated coefficients 0,001-0,005) were encountered for practice level. Use and changes in use on tobacco consumption influenced practitioner's involvement significantly in one dataset, while use and change in alcohol use influenced asking on alcohol consumption in all surveys (-0,01 to -0,05). Moreover Scandinavian and English background influence practitioners positively and Eastern European country situation negatively. Conclusions: Practice variables (workload, gender, age) only influence prevention very little when country differences are accounted for. Use and changes in alcohol use influence involvement of general practitioners in health promotion more. (aut. ref.)