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Patient Tobacco Use in Optometric Practice: A Canada-Wide Study

Kennedy, Ryan David*; Spafford, Marlee M.; Douglas, Ornell; Brûlé, Julie§; Hammond, David*; Fong, Geoffrey T.*; Thompson, Mary E.*; Schultz, Annette S. H.

doi: 10.1097/OPX.0000000000000303
Original Articles

Purpose: A national census survey of optometrists in Canada measured knowledge of ocular diseases associated with smoking cigarettes and current practice behaviors related to addressing tobacco use with patients, including prevention and cessation. Optometrists were also asked to identify tools to assist addressing tobacco use with patients.

Methods: An online bilingual (English/French) survey was developed and an e-mail with a link to the survey was sent to all 4528 optometrists registered in Canada. No participation incentives were provided. Frequency data were tabulated for survey items. Logistic regression models were fit to understand respondent characteristics associated with discussing tobacco use prevention and cessation with patients.

Results: The response rate was 19% (850 responses). Almost all respondents (98%) believed that smoking cigarettes was a risk factor for developing age-related macular degeneration; approximately half (55%) assessed the smoking status of patients during their initial visit; 7% reported that they discussed the benefits of tobacco use prevention with patients younger than 19 years; and 33% reported that they always or regularly assess their patients’ interest in quitting smoking. Respondents who completed the survey in English were more likely (odds ratio, 2.4; 95% confidence interval, 1.01 to 5.65) to deliver prevention messaging, compared with respondents who completed the survey in French. Male respondents were less likely to assess patients’ interest in quitting (odds ratio, 0.7; 95% confidence interval, 0.50 to 0.97) than female respondents. Most respondents (90%) were interested in a continuing education program about the impact of smoking on vision and eye health as well as strategies for discussing tobacco cessation and prevention.

Conclusions: Optometrists are aware of the impact of smoking on ocular health; however, most respondents do not systematically engage in tobacco use prevention and cessation practices. Providing optometrists with tools, including continuing education, may help support patient conversations about the risks of tobacco use and improve public health.




§OD, MSc


Johns Hopkins Bloomberg School of Public Health, Institute for Global Tobacco Control, Department of Health, Behavior, and Society, Baltimore, Maryland (RDK); Propel Centre for Population Health Impact (RDK, OD), University of Waterloo Schools of Optometry and Vision Science (MMS) and Public Health and Health Systems (DH), Department of Psychology (GTF), Department of Statistics and Actuarial Science (MET), University of Waterloo, Waterloo, Ontario, Canada; École d’optométrie, Université de Montréal, Montréal, Quebec, Canada (JB); School of Public Health and Health Systems, Waterloo, Ontario, Canada (DH); Ontario Institute for Cancer Research, Toronto, Ontario, Canada (GTF); and Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada (ASHS).

Ryan David Kennedy Institute for Global Tobacco Control Department of Health, Behavior and Society Johns Hopkins Bloomberg School of Public Health 2213 McElderry Street, 4th Floor Baltimore, MD 21205 e-mail:

© 2014 American Academy of Optometry