Medical Screening Tests Research Articles

Raman hyperspectroscopy of saliva and machine learning for Sjögren’s disease diagnostics

Sjögren's disease is an autoimmune disorder affecting exocrine glands, causing dry eyes and mouth and other morbidities. Polypharmacy or a history of radiation to the head and neck can also lead to dry mouth. Sjogren's disease is often underdiagnosed due to its non-specific symptoms, limited awareness among healthcare professionals, and the complexity of diagnostic criteria, limiting the ability to provide therapy early. Current diagnostic methods suffer from limitations including the variation in individuals, the absence of a single diagnostic marker, and the low sensitivity and specificity, high cost, complexity, and invasiveness of current procedures. Here we utilized Raman hyperspectroscopy combined with machine learning to develop a novel screening test for Sjögren's disease. The method effectively distinguished Sjögren's disease patients from healthy controls and radiation patients. This technique shows potential for development of a single non-invasive, efficient, rapid, and inexpensive medical screening test for Sjögren's disease using a Raman hyper-spectral signature.

The role of nurses in the prevention of cervical cancer: Cervical screening, an unkept promise by the majority of women in Nigeria

ABSTRACT Cervical cancer remains a major public health problem accounting for continuous female death in developing countries. Cervical cancer is the second most common cancer in women globally with an estimated number of 500,000 new cases of cervical cancer and 273,000 mortalities annually. Cervical screening is the best cancer screening test in the history of medicine and most cost-effective of all medical screening tests. The study review aimed to highlight methods of cervical cancer prevention, identify the uptake of cervical screening among women, and explain the role of nurses in uptake of cervical screening. Cervical cancer is preventable and easily treatable if it is detected at early stages, but poor information on prevention and access to screening and treatment contributes to 90% of deaths. In the developing countries such as Nigeria, a large proportion of cervical cancers are diagnosed in advanced stages, with poor rates of survival. The three main methods for preventing cervical cancer are through primary prevention (human papillomavirus vaccination and health education), secondary prevention (cervical screening, early detection of precancerous lesions, and treatment), and tertiary prevention (measures to slow the progression or recurrence, surgical removal, radiotherapy, and chemotherapy). Nurses can help improve the acceptability of this neglected promise by focusing on health education on cervical screening and vaccination in prenatal clinics and infant welfare clinics where there are more women. Inclusion of cyberspace could also serve as a successful and popular platform for this health teaching. All nurses/midwives must preach and fervently work toward the WHO 90–70–90 plan for eradicating cervical cancer.

Prevalence of Various Forms of Active Tuberculosis in Patients with Diabetes

A diabetic foot ulcer (DFU) is a persistent complication of diabetes mellitus. Diabetes is linked to a two to four-fold higher likelihood of developing peripheral arterial disease (PAD) when compared to individuals without diabetes. Objective: To determine the incidence of various forms of active tuberculosis in patients with diabetes. Methods: It was a cross-sectional study conducted at the Department of General Medicine from August 2022 to February 2023. 175 patients, including both males and females, participated in this study. Comprehensive demographic information was meticulously documented for each patient following the appropriate consent procedures. These patients had symptoms such as cough with or without phlegm, hemoptysis, persistent fever, and unexplained weight loss, and their ages ranged from 10 to 85 years. Comprehensive medical history, clinical examination, and TB screening tests were conducted and data analysis were done by SPSS version-24 for further analysis. Results: The mean age was 51.34 years with a standard deviation of 3.61. Among the patients, 107 (61.14%) were male, and 68 (38.85%) were female. The overall prevalence of active TB was 38 cases, accounting for 21.71% of the total. Among these cases, 18 were pulmonary TB, making up 47.36% of the active TB cases, while 13 were extra-pulmonary TB, constituting 34.21% of the total. Additionally, 5 cases were identified as multidrug-resistant TB, representing 13.15% of the active TB cases. Conclusions: In conclusion, our study reveals a higher prevalence of various forms of active tuberculosis in patients with diabetes with pulmonary tuberculosis accounting for 47.35% and extra pulmonary tuberculosis for 34.21% of cases.

The role of fear, disgust, and relevant experience in the assessment of stimuli associated with blood-injury-injection phobia

Individuals with high levels of blood-injection-injury (BII) fears are more likely to avoid health screenings, vaccination, and even minor medical interventions. This could result in more serious health issues, lower quality of life, and even shorter life expectancy. However, still little is known about how various emotions (i.e., fear and disgust) affect subjective evaluation on phobia-related stimuli, and what are the potential risk and protective factors that may change the perception of such stimuli throughout these emotions. We investigated the role of fear of medical interventions and the degree of disgust sensitivity in the evaluation of BII phobia-related content and whether previous relevant experience and age may provide protection against the development of a phobia. We collected online survey data from multiple university sources. Participants (N = 228) completed measures of medical fear, disgust sensitivity, prior relevant experience and medical knowledge. Participants were also asked to rate images related to medical settings on dimensions of valence, arousal, disgust, and threat. Our results suggest that high disgust sensitivity and fear of medical interventions may be a risk factor for avoiding medical settings. However, previous relevant medical experience may function as protective factor. The pandemic of recent years underscored the importance of medical intervention and screening tests. These results have implications for professionals helping (e.g., as counselors) people with BII phobia, and physicians and nurses in informing and treating patients.

Medical screening tests and vaccination among hospital-based physicians in Israel

BackgroundVery few studies have evaluated physician participation in screening tests and vaccinations. The aim was to evaluate attitudes and actual practice of screening tests and vaccinations among hospital-based physicians and to identify factors that predict actual performance.MethodsA cross-sectional study including 220 physicians in various specializations. The study was conducted between January 1, 2017 and December 10, 2017. The statistical analysis was performed during October, 2020 and completed in October 25, 2020.ResultsThe vast majority of physicians (94%) believed in the importance of screening tests for physicians, but less than half actually underwent the tests themselves. A high percentage of physicians measured their BMI (84.5%) and had a serum lipid profile test (67.7%) and complete blood counts (75%) over the previous five years, but less than a third of female physicians over 50 years of age had a mammogram and only 8% of the physicians over 50 had a fecal occult blood test. A high percentage of physicians were vaccinated for Hepatitis A and B, chickenpox and measles (66-96% for the various vaccinations), but only 41% had an influenza vaccination in the previous year. In a multivariate logistic regression model, physicians who believed that hospital physicians bore a responsibility for recommending screening tests to their patients were more likely to have their BMI and their blood pressure checked (OR = 2.234, P = 0.007). They were more likely to undergo laboratory testing (OR = 4.082, P < 0.0001) and tended to get vaccinated more (OR = 1.907, P = 0.051).ConclusionThe rate of screening tests and vaccinations among hospital-based physicians is sub-optimal and very low for fecal occult blood testing and mammograms. Structured programs are required to implement screening tests and vaccinations among physicians.

1.113 Efficacy of Emergency Department (ED) Screening Tests for Children Admitted to an Inpatient Psychiatric Unit for Acute Mental Health Emergencies

1.113 Efficacy of Emergency Department (ED) Screening Tests for Children Admitted to an Inpatient Psychiatric Unit for Acute Mental Health Emergencies

Progress in pediatric obesity: new and advanced therapies

In this review, we discuss new medical and surgical options for the treatment of children and adolescents with obesity. We review the impact of COVID-19 on this vulnerable population. We also discuss the recent availability of screening tests for rare genetic causes of obesity. COVID-19 increased the prevalence of obesity among children and adolescents. This population is at increased risk for severe disease. The field of pediatric obesity has benefited from the approval of two new antiobesity medications: liraglutide and setmelanotide. We discuss indications for their use. New guidelines for surgical options for the treatment of children and adolescents with obesity are reviewed. These options are increasingly used as part of the comprehensive care for these children. The epidemic of childhood obesity continues. COVID-19 and the associated isolation contributed to the problem. However, promising new medical and surgical therapies and screening tests for rare genetic causes of obesity are available. These new diagnostic and therapeutic options bring renewed enthusiasm to the treatment of children and adolescents with obesity and increased recognition that obesity is a chronic disease starting in childhood deserving intervention to prevent consequences.

Rural-Urban Differences in Availability of Telemedicine Services Among Medicare Beneficiaries During COVID-19

The COVID-19 pandemic has created substantial disruptions to all aspects of rural and urban U.S. life. At the same time, it has provided opportunities for shifts in health service delivery, including policy innovations to increase telehealth availability and use for diagnosis and treatment of health concerns. However, it is unclear whether rural residents, particularly older adults, have the same access to telehealth services as their urban counterparts. Rural providers may face unique barriers to delivering telehealth services, and rural patients may have more difficulty accessing those services from their homes. This study used the Fall and Summer 2020 Medicare Current Beneficiary Survey COVID-19 Supplement Public Use Files to examine rural-urban differences in the telemedicine services available to Medicare beneficiaries from their primary care providers, as well as their ability to access those services. Preliminary findings suggest that rural beneficiaries are less likely to have access to telehealth services during the pandemic, they were more likely to exhibit hesitancy towards receiving the COVID-19 vaccine, they were less likely to engage in preventive behaviors such as hand washing and sterilizing surfaces, and more likely to have missed diagnostic or medical screening tests (37%) compared to urban (27%) beneficiaries. Finally, rural beneficiaries were less likely to have a smartphone, computer, or tablet at home and less likely to have access to the internet (78% rural; 84% urban). Policy implications include the need for outreach efforts to better inform the provider community, and efforts to improve rural health system infrastructure available to support telehealth.

Behavioural interventions delivered through interactive social media for health behaviour change, health outcomes, and health equity in the adult population.

Behavioural interventions delivered through interactive social media for health behaviour change, health outcomes, and health equity in the adult population.

The Value of Blood Urea Nitrogen in the Prediction of Risks of Cardiovascular Disease in an Older Population.

Background: High blood urea nitrogen (BUN) is associated with adverse outcomes in patients with cardiac disease risks. However, no study has explored whether BUN can predict the risk of cardiovascular disease (CVD) in the healthy older population. This study aims to explore the incidence and risk factors of CVD among a healthy older population community in China.Design and Methods: This study was designed as a cohort study with a 4-year follow-up. We recruited 5,000 older people among 137,625 residents of the Gaohang community. In the baseline, subjects were asked to participate in medical screening and biological tests, and answered survey questions. During the follow-up period (2014–2017), the researchers regularly tested the subjects' indicators and assessment scales. We monitored the occurrence of CVD and explored the relationship between BUN and CVD via a Cox regression analysis.Results: During the follow-up, subjects were newly diagnosed with CVD including heart failure (HF), heart disease events, atrial fibrillation, diabetes, hypertension, metabolic syndrome, and kidney disease. The Cox regression analysis found an association between baseline BUN and incident CVD in female subjects, with higher BUN associated with increased risk of AF in females and kidney disease in both male and females. No association was found between BUN and CVD in male subjects.Conclusions: Current results indicate that BUN is a valuable predictive biomarker of CVD. A higher BUN level (>13.51 mg/dL) is associated with an increased occurrence of HF but a decreased occurrence of diabetes and metabolic symptoms in normal older females.

Pap Smear Readability on Google: An Analysis of Online Articles Regarding One of the Most Routine Medical Screening Tests

Background: The Papanicolau smear (Pap smear, Pap test) is one of the most routine of all screening tests performed in medicine. Its advent and widespread use has brought a considerable decrease in the incidence of cervical cancer. Unfortunately, this malignancy continues to convey significant morbidity and mortality. Much of this is the result of inadequate compliance with routine Pap smear screening, in which limited education is thought to play a role, particularly among ethnic minorities.&#x0D; Methods: A Google search using the phrase “pap smears” was performed and the first fourteen Uniform Resource Locators were analyzed using four standardized readability indices: the Flesh-Kinkaid Grade Level, the SMOG index, the Gunning Fog Index and the Automated Readability Index. An average grade level readability was then obtained and compared to the AMA recommendation that health care information be written at a 5th or 6th grade reading level.&#x0D; Results: The average grade level readability of the fourteen analyzed sites using four aforementioned indices were 8.86, 8.82, 11.92 and 8.35, respectfully. The total average readability after considering all four indices was 9.49, three grade levels above what the AMA has recommended.&#x0D; Conclusion: The readability of commonly accessed internet information regarding Pap smears is above what is recommended by the AMA. Physicians should be cognizant of this, particularly given this is a routine healthcare test that should be undergone by nearly fifty percent of the world’s population at various points throughout their lifetime.

The Effect of Information Formats and Incidental Affect on Prior and Posterior Probability Judgments

Background. Interpreting medical test results involves judging probabilities, including making Bayesian inferences such as judging the positive and negative predictive values. Although prior work has shown that experience formats (e.g., slide shows of representative patient cases) produce more accurate Bayesian inferences than description formats (e.g., verbal statistical summaries), there are disadvantages of using the experience format for real-world medical decision making that may be solved by presenting relevant information in a 2 × 2 table format. Furthermore, medical decisions are often made in stressful contexts, yet little is known about the influence of acute stress on the accuracy of Bayesian inferences. This study aimed to a) replicate the description-experience format effect on probabilistic judgments; b) examine judgment accuracy across description, experience, and a new 2 × 2 table format; and c) assess the effect of acute stress on probability judgments. Method. The study employed a 2 (stress condition) × 3 (format) factorial between-subjects design. Participants (N = 165) completed a Bayesian inference task in which information about a medical screening test was presented in 1 of 3 formats (description, experience, 2 × 2 table), following a laboratory stress induction or a no-stress control condition. Results. Overall, the 2 × 2 table format produced the most accurate probability judgments, including Bayesian inferences, compared with the description and experience formats. Stress had no effect on judgment accuracy. Discussion. Given its accuracy and practicality, a 2 × 2 table may be better suited than description or experience formats for communicating probabilistic information in medical contexts.

(Invited) Optics-Based Wearable Device for Real-Time Monitoring of Newborn Jaundice

NoveltyA wearable optical device for real-time monitoring of newborn jaundice was developed (Fig. 1). Jaundice is caused by the accumulation of bilirubin in an infant's blood. Bilirubin levels measured using the newly developed sensor were comparable to those measured using a commercial jaundice meter(R = 0.86). Real-time monitoring of the bilirubin level in infants is required because the level can change rapidly and affect their growth. The real-time monitor evaluates jaundice by calculating the ratio of the reflected light intensity between blue (470 nm) and green (570 nm) wavelengths. The data can be transferred conveniently to a smartphone. The ability of the newly developed sensor to measure bilirubin levels was comparable to that of a commercial jaundice device (R = 0.86), indicating the sensor could successfully evaluate jaundice. This wearable sensor is an important advance in the healthcare of infants, as it provides real-time monitoring of jaundice, one of the most important medical parameters in preliminary medical screening tests for newborns. BackgroundThe liver of an infant is immature, and its function must be monitored periodically. An important parameter indicating liver function is bilirubin, which is generated during the breakdown of hemoglobin. The immature liver of an infant cannot breakdown the generated bilirubin quickly enough. As a result, bilirubin accumulates in the skin tissue, resulting in jaundice. Without appropriate treatment, bilirubin is deposited into the brain, which can lead to brain damage. Moreover, permissible bilirubin levels are dependent on the baby’s age. Therefore, it is crucial to measure bilirubin levels continuously in newborns in order to discover symptoms of jaundice as early as possible. Conventionally, bilirubin levels are measured using a blood sampling method[1] or an optical method[2]. The blood sampling method can measure bilirubin levels with high accuracy; however, this method is invasive. In light of this, the non-invasive optical method is more commonly used. However, even with the optical method, it is difficult to measure bilirubin levels continuously because conventional optical devices are large and burdensome to medical staff and infants. Furthermore, it is impossible for these two methods to detect a sudden change in the bilirubin level. The present study proposes the development of a wearable jaundice monitor that can be worn on the forehead of an infant and measure bilirubin levels in real time. Device Fabrication and Experimental ResultsAs shown figure 1, the wearable optical jaundice sensor was miniaturized by using two light-emitting diodes (LEDs) of different wavelengths (blue and green) and four photodiodes (PDs)(Fig. 1b). The flexible polyimide substrate of the device fabricated by soft lithography enables conformal coverage of the electronic components on soft, curved surfaces of the skin(Fig. 1c). Transmitted light from the LEDs irradiates the skin surface, and reflected light is detected by the PDs. The sensor detects the difference in the intensity of the reflected blue and green light. In addition, a wireless function, using a Bluetooth wireless network and original smartphone/Tablet applications, permits real-time measurements. The blue light is highly associated with the concentration of bilirubin, compared to the green light. For measurements of the reflected blue and green light, the LEDs are alternately illuminated in 40 ms. Calculation of the bilirubin concentration from the differences in the intensities is based on the Beer-Lambert Law. In a preliminary experiment, the calculated ratio of reflected light intensities was associated with the value measured using a commercial jaundice meter (R = 0.86). The present work represents an important step towards safer, more advanced technologies for infant healthcare made possible by the Internet of Things. Figure 1: Photograph of an actual wearable jaundice device. a. The package of the device is made of silicone rubber. b, c. Electrical components are mounted on flexible polyimide substrate. Optical sensing part is composed of four PDs, blue and green LEDs. Figure 1

Severe hypercholesterolemia in a 2-year-old

Routine and selective cholesterol screening of children is an effective tool to help identify those with familial hypercholesterolemia. In children found to have elevated levels of cholesterol, secondary causes should be excluded, including hypothyroidism. Thyroid hormone has multiple effects on the regulation of lipid synthesis, absorption, and metabolism. In this case report, we described a 2-year-old with a history of congenital hypothyroidism who was found to have severe hypercholesterolemia. A detailed medical history and appropriate screening tests are important in determining the underlying cause of elevated low-density lipoprotein cholesterol to help inform clinical decision-making.

Use of Preventive Health Services Among Cancer Survivors in the U.S.

With improvements in early detection and treatment, a growing proportion of the population now lives with a personal history of a cancer. Although many cancer survivors are in excellent health, the underlying risk factors and side effects of cancer treatment increase the risk of medical complications and secondary malignancies. The 2013 National Health Interview Survey was utilized to assess the association between personal history of cancer and receipt of U.S. Preventive Services Task Force-recommended services, comprising three cancer screening tests (mammography, colonoscopy, and Pap smear) and six general medical preventive care services (aspirin for prevention of cardiovascular disease; blood pressure, cholesterol, and diabetes screening; diet/activity counseling; and tobacco use counseling). For each preventive service, patients with a history that would preclude that test were excluded. One to three matching of cancer survivors to controls was performed using propensity scores generated from patient-level demographic variables. Conditional logistic regression models were employed to compare odds of screening between matched cohorts of cancer survivors and controls. The years of analysis were 2015 and 2017. A total of 2,639 cancer patients and 31,885 controls were extracted from the merged 2013 National Health Interview Survey. In the propensity score-matched cohorts of eligible adults, only one of the three cancer screening tests, colorectal, was more common in cancer survivors (OR=1.52, 95% CI=1.32, 1.75, p<0.001), whereas breast and cervical cancer screening were not more common in survivors. By contrast, all of the medical screening tests, with the exception of diabetes screening, were more common among cancer survivors. The association between receipt of recommended preventive medical care and personal history of cancer varied, depending on the preventive service in question, but in the majority of preventive services assessed, cancer survivors had more frequent screening compared with non-cancer survivors.

3D Printed “Earable” Smart Devices for Real-Time Detection of Core Body Temperature

Real-time detection of basic physiological parameters such as blood pressure and heart rate is an important target in wearable smart devices for healthcare. Among these, the core body temperature is one of the most important basic medical indicators of fever, insomnia, fatigue, metabolic functionality, and depression. However, traditional wearable temperature sensors are based upon the measurement of skin temperature, which can vary dramatically from the true core body temperature. Here, we demonstrate a three-dimensional (3D) printed wearable "earable" smart device that is designed to be worn on the ear to track core body temperature from the tympanic membrane (i.e., ear drum) based on an infrared sensor. The device is fully integrated with data processing circuits and a wireless module for standalone functionality. Using this smart earable device, we demonstrate that the core body temperature can be accurately monitored regardless of the environment and activity of the user. In addition, a microphone and actuator are also integrated so that the device can also function as a bone conduction hearing aid. Using 3D printing as the fabrication method enables the device to be customized for the wearer for more personalized healthcare. This smart device provides an important advance in realizing personalized health care by enabling real-time monitoring of one of the most important medical parameters, core body temperature, employed in preliminary medical screening tests.

Pregnancy-associated plasma protein-A truncation limits in antenatal screening for trisomy 18.

Upper and lower truncation limits are commonly applied to quantitative markers used in medical screening tests. We here examine data on 375 trisomy 18 and 522,081 unaffected singleton pregnancies, to determine if the lower truncation limit should be set below the previously specified 0.2 multiples of the median. A lower truncation limit of 0.15 would reduce the underestimation of the risk of having a trisomy 18 pregnancy in about 50% of affected pregnancies and would lead to an estimated 10 percentage point increase in the detection rate, with only a very small increase in the false-positive rate.

Clinically healthy overweight and obese dogs differ from lean controls in select CBC and serum biochemistry values.

Obesity is a global disease, affecting nearly half a billion people. Unfortunately, this trend is mirrored in our canine population. As obesity is a complex inflammatory disease, there is a need to determine whether routine medical screening tests may indicate, or be influenced by, its presence. The objective of the current study was to determine if significant differences exist between CBC and biochemical profile values from control vs overweight/obese, client-owned dogs considered clinically healthy. Dogs presented for routine health examinations, including minor dental or elective surgical procedures, were retrospectively identified from a hospital population. Animals were allocated to 2 categories based on body condition score (BCS), and data were analyzed by Mann-Whitney nonparametric analysis with statistical significance at a P ≤ .05. After exclusions, 116 dogs were assigned to the overweight/obese group (BCS ≥ 7) and 240 dogs to the control group (BCS = 4-6). Overweight/obese dogs had higher total leukocyte counts and higher plasma protein and globulin concentrations. Other differences were attributed to decreased serum water fraction (increased sodium, albumin, calcium, and anion gap) in the overweight/obese group. Interestingly, chloride concentration was decreased (in the face of increased sodium) in the obese group. There is CBC and biochemical evidence to support the concern that obesity influences laboratory values, even in dogs considered clinically healthy. Prospective studies aimed at characterizing these changes are needed to provide insight into the connection between obesity and its comorbidities.

Racial Disparities in Screening Mammography in the United States: A Systematic Review and Meta-analysis

PurposeMany studies have suggested that disparities exist in the use of medical screening tests. The purpose of this study was to assess racial disparities in screening mammography in the United States via a systematic review and meta-analysis. MethodsWe searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus for comparative studies published between 1946 and 2015 comparing utilization of mammography among various racial groups. Two independent reviewers extracted data and appraised study. Meta-analysis was conducted when appropriate using the random-effects model. ResultsA total of 5,818,380 patients were included across 39 relevant studies; 43.1% of patients were white, 33.3% were black, 17.4% were Hispanic, and 6.2% were Asian/Pacific Islander. Black and Hispanic populations had lower odds of utilizing screening mammography when compared with the white population (odds ratio [OR] = 0.81; 95% confidence interval [CI], 0.72-0.91; I2 = 89.4% and OR = 0.83; 95% CI, 0.74-0.93, respectively). For African Americans, these disparities were present in both the 40 to 65 age group and the >65 age group; for Hispanics, these differences were present only in the 40 to 65 age group. There was no difference in mammography utilization between Asians/Pacific Islanders and whites (OR = 1.82; 95% CI, 0.09-38.41). ConclusionsRacial disparities in utilization of screening mammography are evident in black and Hispanic populations in the United States. Further studies are needed to understand reasons for disparities, trends over time, and the effectiveness of interventions targeting these disparities.

Providers' advice concerning smoking cessation: Evidence from the Medical Expenditures Panel Survey

Importance and objectiveWe estimate how often adult smokers are advised to quit using a nationally representative sample of adults in the United States. Design and participantsData are from the 2012–2013 household component of the United States (US) Medical Expenditures Panel Survey (MEPS). Main outcome measureCurrent smoking and advice to quit offered by providers. ResultsSmoking was reported by 18.26% (CI 17.13%–19.38%) of 2012 MEPS respondents. Less than half of adult smokers (47.24%, CI 44.30%–50.19%) were advised to quit by their physicians although 17.57% (CI 15.37%–19.76%) had not seen a doctor in the last 12months. Advice to quit was given significantly less often to respondents classified as: aged 18–44 (40.29%), men (40.20%), less educated (42.26%), lower family income (43.51%), Hispanic (33.82%), never married (39.55%), and living outside the northeast. Smoking status at year 2 for patients who had received advice to quit was similar (85.13%: SE 1.62%) to those who had seen a physician but were not advised to quit (81.95%: SE 2.05%). Advice to quit smoking was less common than the use of common medical screening tests. Conclusions and relevanceSmoking cessation advice is given to less than half of current cigarette smokers and it is least likely to be given to the most vulnerable populations. Efforts to reduce smoking are deployed less often than other preventive practices. The rate of advice to quit has not changed over the last decade. Health care providers are missing an important opportunity to affect health behaviors and outcomes.