Increased awareness enhances physician recognition of the role of smoking in chronic pancreatitis
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pancreatitis, etiology, risk factors, smoking, doctors’ awareness

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Muniraj, T., Yadav, D., Abberbock, J. N., Alkaade, S., Amann, S. T., Anderson, M. A., Banks, P. A., Brand, R. E., Conwell, D., Cote, G. A., Forsmark, C. E., Gardner, T. B., Gelrud, A., Guda, N., Lewis, M. D., Romagnuolo, J., Sandhu, B. S., Sherman, S., Singh, V. K., Slivka, A., Tang, G., Whitcomb, D. C., & Wilcox, C. M. (2020). Increased awareness enhances physician recognition of the role of smoking in chronic pancreatitis. Herald of Pancreatic Club, 48(3), 23-31.

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Background: We have previously reported that physicians under-recognize smoking as a chronic pancreatitis (CP) risk factor. We hypothesized that availability of empiric data will influence physician recognition of this relationship.

Methods: We analyzed data from 508 CP patients prospectively enrolled in the North American Pancreatitis Study-2 Continuation and Validation (NAPS2-CV) or NAPS2-Ancillary (AS) studies (2008–2014) from 26 US centers who self-reported ever-smoking. Information on smoking status, physician-defined etiology and identification of smoking as a CP risk factor was obtained from structured patient and physician questionnaires. We compared how often physician identified smoking as a CP risk factor in NAPS2-CV/NAPS2-AS studies with NAPS2-original study (2000–2006).

Results: Enrolling physician identified smoking as a risk factor in significantly (all p< 0.001) greater proportion of patients in NAPS2-CV/AS studies when compared with NAPS2-original study among ever (80.7 vs. 45.3%), current (91.3 vs. 53%), past (60.3 vs. 30.2%) smokers, in those who smoked ≤1 pack/day (79.3 vs. 39.5%) or ≥1 packs/day (83 vs. 49.8%). In multivariable analyses, the enrolling physician was 3.32–8.49 times more likely to cite smoking as a CP risk factor in the NAPS2-CV/NAPS2-AS studies based on smoking status and amount after controlling for age, sex, race and alcohol etiology. The effect was independent of enrolling site in a sub-analysis limited to sites participating in both phases of enrollment.

Conclusions: Availability of empiric data likely enhanced physician recognition of the association between smoking and CP. Wide-spread dissemination of this information could potentially curtail smoking rates in subjects with and those at risk of CP.
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