[' ', 'SO', 'ny', 'ating', 'ites', 'aia', 'REL', 'Bee', 'ete', '‘Commentary', 'a', 'The', 'New', 'Vital', 'Sign', 'Assessing', 'and', 'Documenting', 'Smoking', 'Status', 'AT', 'THE', 'turn', 'of', 'the', 'last', 'century,', 'the', 'American', 'medical', 'community', 'developed', 'a', 'standardized', 'assessment', 'to', 'help', 'cli-', 'nicians', 'confront', 'the', 'leading', 'cause', 'of', 'death', 'at', 'that', 'time,', 'infectious', 'disease.', 'This', 'assessment,', 'known', 'as', 'vital', 'signs,', 'included', 'temperature,', 'pulse', 'rate,', 'respiratory', 'rate,', 'and,', 'later,', 'blood', 'pressure.*', 'Over', 'time,', 'the', 'measurement', 'of', 'vital', 'signs', 'became', 'an', 'expected', 'part', 'of', 'every', 'clinic', 'visit', 'and', 'an', 'essential', 'component', 'of', 'the', 'database', 'physicians', 'use', 'to', 'evaluate,', 'diag-', 'nose,', 'and', 'treat', 'patients.', 'See', 'also', 'pp', '3139', 'and', '3172.', ' ', 'As', 'we', 'approach', 'the', 'next', 'century,', 'American', 'medicine', 'is', 'challenged', 'by', 'a', 'different', 'cause', 'of', 'illness', 'and', 'death—tobacco', 'use.', 'Cigarettes', 'are', 'now', 'responsible', 'for', 'more', 'than', '430000', 'deaths', 'each', 'year', 'in', 'the', 'United', 'States.‘', 'As', 'with', 'past', 'epi-', 'demics', 'of', 'this', 'magnitude,', 'institutional', 'changes', 'in', 'the', 'prac-', 'tice', 'of', 'medicine', 'must', 'be', 'adopted', 'to', 'overcome', 'the', 'enormous', 'disease', 'burden', 'resulting', 'from', 'tobacco', 'use.', 'Making', 'smoking', 'status', 'the', '“new', 'vital', 'sign”', 'is', 'a', 'simple', 'way', 'to', 'confront', 'the', 'chief', 'avoidable', 'cause', 'of', 'illness', 'and', 'death', 'in', 'our', 'society', 'today.', 'This', 'small', 'but', 'fundamental', 'change', 'in', 'clinical', 'practice', 'will', 'begin', 'to', 'address', 'a', 'current', 'weakness', 'in', 'the', 'way', 'we', 'practice', 'medicine—the', 'failure', 'to', 'universally', 'assess,', 'document,', 'and', 'intervene', 'with', 'patients', 'who', 'smoke.', 'Current', 'standards', 'of', 'practice', 'warrant', 'appropriate', 'documen-', 'tation', 'and', 'intervention', 'for', 'elevated', 'blood', 'pressure,', 'increased', 'temperature,', 'and', 'arrhythmias.', 'Adding', 'smoking', 'status', 'as', 'a', 'new', 'vital', 'sign', 'will', 'significantly', 'increase', 'the', 'likelihood', 'for', 'intervention', 'in', 'this', 'important', 'area', 'as', 'well.', 'In', 'the', 'current', 'issue', 'of', 'THE', 'JOURNAL,', 'Frank', 'and', 'col-', 'leagues®', 'provide', 'compelling', 'evidence', 'that', 'this', 'institutional', 'change', 'is', 'needed.', 'These', 'authors,', 'in', 'a', 'large,', 'well-conducted', 'study,', 'have', 'convincingly', 'documented', 'that', 'fewer', 'than', 'half', 'of', 'all', 'smokers', 'reported', 'that', 'they', 'had', 'ever', 'been', 'advised', 'by', 'their', 'physicians', 'to', 'quit', 'or', 'cut', 'down.', 'This', 'disappointingly', 'low', 'rate', 'of', 'smoking', 'status', 'assessment', 'was', 'observed', 'across', 'most', 's0-', 'ciodemographic', 'subpopulations', 'and', 'was', 'particularly', 'low', 'among', 'young', 'smokers', 'and', 'women', 'who', 'both', 'smoked', 'and', 'used', 'eral', 'contraceptives.', 'A', 'meager', '4%', 'of', 'smokers', 'reported', 'that', 'their', 'physician', 'had', 'helped', 'them', 'quit.', 'These', 'findings', 'are', 'regrettably', 'similar', 'to', 'those', 'of', 'an', 'earlier', 'study', 'of', 'smokers', 'in', 'Michigan,', 'only', '44%', 'of', 'whom', 'reported', 'that', 'a', 'physician', 'had', 'ever', 'told', 'them', 'to', 'quit.®', 'In', 'both', 'of', 'these', 'studies,', 'had', 'smoking', 'status', 'been', 'assessed', 'during', 'the', 'routine', 'documentation', 'of', 'nn', '.', 'From', 'the', 'Department', 'of', 'Medicine', 'and', 'the', 'Tobacco', 'Research', 'and', 'intervention', 'Program,', 'University', 'of', 'Wisconsin', 'Medical', 'School,', 'Madison.', 'Reprint', 'requests', 'to', 'Tobacco', 'Research', 'and', 'Intervention', 'Program,', 'University', 'of', 'Wisconsin', 'Medical', 'School,', '7275', 'Medica!', 'Sciences', 'Center,', '1300', 'University', 'Ave,', 'Madison,', 'WI', '53706', '(Dr', 'Fiore).', 'JAMA,', 'December', '11,', '1991—Vol', '266,', 'No.', '22', 'vital', 'signs,', 'these', 'distressingly', 'low', 'rates', 'could', 'have', 'been', 'markedly', 'improved.', 'Most', 'patients', 'don’t', 'object', 'to', 'having', 'their', 'blood', 'pressure', 'measured', 'during', 'every', 'clinic', 'visit,', 'and', 'there', 'are', 'no', 'data', 'to', 'suggest', 'that', 'they', 'would', 'object', 'to', 'the', 'regular', 'assessment', 'of', 'smoking', 'status,', 'particularly', 'if', 'presented', 'in', 'the', 'context', 'ofrou-', 'tine', 'preventive', 'care.”§', 'In', 'fact,', 'assessing', 'smoking', 'status', 'at', 'every', 'visit', 'might,', 'by', 'itself,', 'motivate', 'some', 'smokers', 'to', 'con-', 'sider', 'making', 'a', 'quit', 'attempt.', 'Making', 'smoking', 'status', 'a', 'vital', 'sign', 'would', 'also', 'promote', 'the', 'guidelines', 'of', 'the', 'US', 'Preventive', '.', 'Services', 'Task', 'Force®', 'that', '“tobacco', 'cessation', 'counseling', 'should', 'be', 'offered', 'on', 'a', 'regular', 'basis', 'to', 'all', 'patients', 'who', 'smoke', 'cigarettes”', 'and', 'the', 'National', 'Health', 'Promotion', 'and', 'Disease', 'Prevention', 'Objectives', 'for', 'the', 'Year', '2000"', 'to', '“increase', 'to', 'at', 'least', '75%', 'the', 'proportion', 'of', 'primary', 'care', 'and', 'oral', 'health', 'care', 'providers', 'who', 'routinely', 'advise', 'cessation', 'and', 'provide', 'assis-', 'tance', 'and', 'follow-up', 'for', 'all', 'of', 'their', 'tobacco-using', 'patients.”', 'The', 'singularly', 'devastating', 'health', 'impact', 'of', 'cigarette', 'smok-', 'ing', 'warrants', 'the', 'unique', 'institutional', 'response', 'of', 'expanding', 'the', 'vital', 'signs.', 'While', 'not', 'by', 'itself', 'sufficient,', 'the', 'elevation', 'of', 'smoking', 'assessment', 'to', 'the', 'priority', 'status', 'of', '“a', 'vital', 'sign”', 'would', 'be', 'an', 'important', 'first', 'step', 'in', 'a', 'coordinated', 'action', 'plan', 'for', 'physicians', 'to', 'aggressively', 'confront', 'smoking.', 'This', 'action', 'plan', 'would', 'include', 'the', 'following:', '©', 'Assess', 'and', 'document', 'smoking', 'status', 'as', 'part', 'of', 'the', 'vital', 'signs', 'for', 'every', 'patient', 'during', 'every', 'clinical', 'visit.', 'Seventy', 'percent', 'of', 'smokers', 'visit', 'a', 'physician', 'each', 'year,”', 'and', 'most', 'of', 'them', 'are', 'motivated', 'to', 'quit.', 'Adding', 'smoking', 'status', 'to', 'the', 'vital', 'signs', 'assessment,', 'an', 'activity', 'usually', 'completed', 'by', 'a', 'nurse', 'or', 'medical', 'assistant', 'prior', 'to', 'the', 'physician’s', 'encounter,', 'will', 'ensure', 'that', 'all', 'smokers', 'are', 'identified.', 'A', 'model', 'vital', 'sign', 'stamp”', 'that', 'includes', 'smoking', 'status', 'assessment', 'is', 'shown', 'in', 'the', 'Figure.', '.', '®@', 'Learn', 'and', 'use', 'a', 'brief', 'intervention', 'message', 'to', 'help', 'pa-', 'tients', 'to', 'quit.', 'Physicians,', 'once', 'aware', 'of', 'the', 'smoking', 'status', 'of', 'their', 'patients,', 'can', 'then', 'focus', 'on', 'moving', 'smokers', 'from', 'the', 'stage', 'of', 'contemplating', 'quitting', 'to', 'making', 'a', 'quit', 'attempt.', 'To', 'do', 'this,', 'physicians', 'must', 'become', 'comfortable', 'with', 'a', 'brief', 'clin-', 'ical', 'intervention', 'to', 'assist', 'their', 'patients', 'who', 'smoke.', 'The', 'Na-', 'tional', 'Cancer', 'Institute', 'has', 'developed', 'guidelines,', 'based', 'on', 'the', 'results', 'of', 'a', 'large', 'series', 'of', 'clinical', 'trials,', 'for', 'an', 'effective,', '2-', 'to', '38-minute', 'clinical', 'intervention', 'for', 'physicians', '(How', 'to', 'Help', 'Your', 'Patients', 'Quit', 'Smoking)."', 'These', 'guidelines', 'and', 'the', 'Na-', 'tional', 'Cancer', 'Institute’s', 'program', 'to', 'train', '100000', 'physicians', 'are', 'summarized', 'in', 'an', 'important', 'report', 'by', 'Manley', 'and', 'col-', 'leagues"', 'in', 'this', 'issue', 'of', 'THE', 'JOURNAL.', 'These', 'authors', 'have', 'estimated', 'that', '3', 'million', 'smokers', 'would', 'quit', 'annually', 'if', 'this', 'intervention', 'were', 'universally', 'adopted', 'and', 'succeeded', 'with', 'as', 'few', 'as', '10%', 'of', 'American', 'smokers.', 'While', 'physicians', 'routinely', 'advise', 'and', 'counsel', 'patients', 'with', 'diabetes,', 'hypertension,', 'or', 'even', 'a', 'sprained', 'ankle,', 'they', 'have', 'lagged', 'in', 'delivering', 'a', 'brief', 'Commentary', '3183', ' ', ' ', ' ', 'VOT8', '86L0g']