Tobacco Screening Research Articles

Health care system collaboration to address chronic diseases: a nationwide snapshot from state public health practitioners.

IntroductionUntil recently, health care systems in the United States often lacked a unified approach to prevent and manage chronic disease. Recent efforts have been made to close this gap through various calls for increased collaboration between public health and health care systems to better coordinate provision of services and programs. Currently, the extent to which the public health workforce has responded is relatively unknown. The objective of this study is to explore health care system collaboration efforts and activities among a population-based sample of state public health practitioners.MethodsDuring spring 2013, a national survey was administered to state-level chronic disease public health practitioners. Respondents were asked to indicate whether or not they collaborate with health care systems. Those who reported “yes” were asked to indicate all topic areas in which they collaborate and provide qualitative examples of their collaborative work.ResultsA total of 759 respondents (84%) reported collaboration. Common topics of collaboration activities were tobacco, cardiovascular health, and cancer screening. More client-oriented interventions than system-wide interventions were found in the qualitative examples provided. Respondents who collaborated were also more likely to use the Community Guide, use evidence-based decision making, and work in program areas that involved secondary, rather than primary, prevention.ConclusionThe study findings indicate a need for greater guidance on collaboration efforts that involve system-wide and cross-system interventions. Tools such as the Community Guide and evidence-based training courses may be useful in providing such guidance.

Nicotine dependence and psychiatric and substance use disorder comorbidities among American Indians/Alaska Natives: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions

BackgroundAmerican Indians and Alaska Natives (AI/ANs) have high rates of tobacco use compared to the general population. AI/ANs also have elevated rates of psychiatric and substance use disorders associated with nicotine dependence. However, very few studies have examined the comorbidity between nicotine dependence and psychiatric and substance use disorders within this population. MethodsThis study analyzes the comorbidity of lifetime nicotine dependence with both current and lifetime psychiatric disorders and substance use disorders in a nationally representative sample of 701 AI/AN women and men. ResultsUsing 95% confidence interval testing, lifetime nicotine dependence (29.5%) was associated with all main diagnostic categories (any mood disorder, any anxiety disorder, any personality disorder, any alcohol use disorder, and any drug use disorder) both at the lifetime level and current (12-month) level. Of the lifetime disorders, the strongest associations were with psychosis and drug dependence. For (current) 12-month disorders, the strongest associations were with alcohol dependence and drug dependence. Differences were noted between genders regarding personality disorders. ConclusionsCulturally appropriate tobacco screening, prevention, and treatment curricula for adult AI/ANs with dual diagnoses are recommended. Understanding historically based factors that may contribute to psychiatric illness and substance use disorders may assist in more effective nicotine treatments for AI/ANs.

Assessing the relationship between medical residents' perceived barriers to SBIRT implementation and their documentation of SBIRT in clinical practice

Of the 17.9 million adult Americans who have an alcohol use disorder, most (89%) are unaware of their condition.1 The Centers for Disease Control and Prevention (CDC) lists more than 30 specific immediate and long-term health risks associated with excessive alcohol use,2 suggesting that identifying and addressing alcohol use is an important component of primary medical care. Screening, brief intervention, and referral to treatment (SBIRT) is an integrated and validated approach to identifying risky or problematic alcohol use and providing services to those who need them.3 In 2009, Indiana University School of Medicine (IUSM) reached a cooperative agreement with the Substance Abuse and Mental Health Services Administration (SAMHSA) to begin training its medical residents in SBIRT. The training curriculum focuses on delivery of SBIRT services using motivational interviewing techniques (MI). In addition to developing this curriculum and integrating it into the first year of medical residency at IUSM, we developed a protocol for implementing SBIRT services at an internal medicine continuity clinic. This clinic is part of a larger safety-net health system in Indianapolis at which some residents are assigned a small panel of patients during their internal medicine residency. At the time of the study, the continuity clinic was classified as a community health centre, though it since has received federally qualified health center (FQHC) designation. Medical conditions presenting in the clinic vary, with a predominance of adult chronic diseases such as hypertension, heart failure, diabetes, and chronic obstructive lung disease. At each visit, all adult patients were screened for alcohol, drug, and tobacco use by a medical assistant (MA) using the AUDIT-C tool and single drug and tobacco screening questions. These data were given to care providers, both medical residents and staff physicians, to enable delivery of targeted SBIRT services. At the conclusion of each clinical encounter, providers were then asked to document the components of SBIRT that they completed by responding to four yes/no statements, such as ‘I referred the patient to a substance abuse counselor.’ However, across 9954 initial physician visits with unique patients that occurred between 1/31/2011 and 6/29/2012 (hereafter ‘the study period’), we observed a high frequency of incomplete SBIRT encounter forms (83.8%), meaning that the physicians generally were not documenting whether they completed SBIRT. While this was seen as a cause for concern, logically, we could not conflate incomplete forms with a failure to provide SBIRT services. We therefore were moved conceptually to separate two distinct behaviours: actually performing SBIRT, and documenting that SBIRT was completed. In order for SBIRT to be an integrated part of primary medical care, all associated processes and results need to be recorded. Since we have access to evaluative data collected during their SBIRT training that assesses residents’ anticipated barriers to utilizing SBIRT and MI in their medical practice, we examined whether medical residents’ self-reported barriers to performing SBIRT or using MI in their clinical practice predicted appropriate SBIRT documentation in their clinical practice.

Emergency department provider preferences related to clinical practice guidelines for tobacco cessation: a multicenter survey.

The objective was to assess current emergency department (ED) provider practices and preferences for tobacco cessation interventions. The ED is an opportune place to initiate smoking cessation interventions. However, little is known about ED provider current practices and preferences for cessation counseling in the ED. This was a survey of ED providers conducted in 2008-2009 (including physicians, nurse practitioners, physician assistants, and nurses), working at least half-time at 10 U.S. academic EDs, regarding adherence to clinical practice guidelines ("5 As") and preferences for cessation interventions/styles. Data analysis occurred in 2012-2013. The response rate was 64% (800 out of 1,246 completed surveys). Providers reported strongest adherence to asking about patient smoking status, followed by advising, with significant variance by clinical role. Assessing, assisting, and arranging support for patients was low overall. Most frequently used interventions were to provide patients with a list of telephone numbers for stop-smoking counseling (87%), pamphlets on smoking health risks and the benefits of stopping (85%), and referrals to the National Toll-Free Smoker's Quitline (84%). Most providers (80%) were supportive of personally conducting brief (less than 3minutes) smoking cessation counseling sessions during the ED visit, emphasizing education and encouragement. The least appealing intervention was writing a prescription for nicotine replacement therapies or medications to stop smoking (35%). Interventions most likely to be used were brief and delivered with a positive tone and included referral to external resources. The logical next step is to design and test interventions that ED providers find acceptable.

The unique challenges facing HIV-positive patients who smoke cigarettes: HIV viremia, ART adherence, engagement in HIV care, and concurrent substance use.

Evidence suggests that smoking may have negative associations with HIV health outcomes. The smoking rate in our sample of people living with HIV (N = 333) was triple that of the general population (57 v. 19 %). Regression analyses revealed that (smokers v. non-smokers) reported lower medication adherence (unstandardized beta = 9.01) and were more likely to have a detectable viral load (OR = 2.85, 95 % CI [1.53-5.30]). Smokers attended fewer routine medical visits (β = -0.16) and were more likely to report recent hospitalization (OR = 1.89, 95 % CI [0.99, 3.57]). Smokers ranked "health" as less important to their quality of life (β = -0.13) and were more likely to report problematic alcohol (OR = 2.40, 95 % CI [1.35, 4.30]), cocaine (OR = 2.87, 95 % CI [1.48-5.58]), heroin (OR = 4.75, 95 % CI [1.01, 22.30]), or marijuana use (OR = 3.08, 95 % CI [1.76-5.38]). Findings underscore the need for integrated behavioral smoking cessation interventions and routine tobacco screenings in HIV primary care.

Using Internet to Recruit Immigrants with Language and Culture Barriers for Tobacco and Alcohol Use Screening: A Study Among Brazilians

Limited English proficient (LEP) individuals face disparities in accessing substance abuse treatment, but little is known on how to reach this population. This study aimed to test online recruitment methods for tobacco and alcohol screening among LEP Portuguese speakers. The study was advertised in Portuguese using Facebook, Google, online newsletters and E-mail. Participants clicked ads to consent and access a screening for tobacco and alcohol dependence. Ads yielded 690 screening responses in 90 days. Respondents had a mean age of 42.7 (SD 12), with a higher proportion of women than men, 95% born in Brazil with high levels of LEP and low levels of acculturation. Facebook ads yielded 41.4% of responses, and were the lowest cost recruitment channel ($8.9, $31.10 and $20.40 per respondent, hazardous drinker and smoker, respectively). Online recruitment of LEP populations is feasible. Future studies should test similar strategies in other LEP groups.

Triple tobacco screen: opportunity to help families become smokefree.

American Academy of Pediatrics policy recommends that pediatricians document environmental tobacco smoke (ETS) exposure of a child at every visit. The extent to which pediatricians adhere to this policy, however, is unknown. The goal of the study was to examine the extent to which pediatricians screen parents for tobacco use and home- and car-related smoking rules. Further, the potential association between factors associated with pediatrician inquiry into parental tobacco use and rules is examined. Post-visit exit interviews were conducted in ten pediatric practices between June 2009 and March 2011 with parents whose children had been seen by a healthcare provider. Parents were considered to have been given the "triple tobacco screen" if they reported being asked by a pediatric healthcare provider about their smoking behavior, smokefree home rules, and smokefree car rules. Bivariate analysis and multivariable logistic regression was done to explore factors associated with parents being given any component of the triple tobacco screening. Data were analyzed between March 2012 and February 2013. Of 9145 parents interviewed, 20% of the parents reported being asked at least one question from the triple tobacco screen, and only 9% reported being asked all three questions. Overall, 17% of parents reported being asked about their smoking status, 16% about smokefree home rules, and 11% about smokefree car rules. Few smoking parents (23%) and fewer nonsmoking parents (19%) were screened about their tobacco use and behavior. Pediatricians infrequently addressed ETS exposure of children among parents who do and do not smoke. Substantial missed opportunities may exist to counsel smokers and reduce ETS exposure of children in the most common exposure locations-the home and car.

Tobacco use screening and treatment by outpatient psychiatrists before and after release of the American Psychiatric Association treatment guidelines for nicotine dependence.

We examined tobacco use screening and treatment by US psychiatrists before and after release of the 1996 American Psychiatric Association (APA) nicotine dependence treatment guidelines. We used data from the National Ambulatory Medical Care Survey to identify rates of tobacco screening and treatment by psychiatrists before the release of the guidelines (1993-1996) and during 2 postguidelines periods: 2001-2005 and 2006-2010. Multiple logistic regression was used to compare preguidelines and postguidelines rates. Psychiatrists screened for tobacco use during 77% of visits from 1993 to 1996, 69% of visits from 2001 to 2005 (odds ratio [OR] = 0.69; 95% confidence interval [CI] = 0.64, 0.75), and 60% of visits from 2006 to 2010 (OR = 0.46; 95% CI = 0.43, 0.50). Psychiatrists provided cessation counseling to 12% of smokers from 1993 to 1996, 11% from 2001 to 2005 (OR = 0.97; 95% CI = 0.74, 1.26), and 23% from 2006 to 2010 (OR = 2.23; 95% CI = 1.74, 2.86). Psychiatrists prescribed nicotine replacement therapy to fewer than 1% of smokers during all 3 time periods. Psychiatrists are screening for tobacco use at declining rates, and the proportion of smokers provided with treatment remains low.

Parental Tobacco Screening and Counseling in the Pediatric Emergency Department: Practitioners’ Attitudes, Perceived Barriers, and Suggestions for Implementation and Maintenance

IntroductionThe pediatric emergency department (PED) is a venue that underuses parental tobacco screening and brief cessation counseling. We sought to explore PED practitioners’ attitudes and perceived barriers regarding the implementation and adoption of tobacco screening/cessation counseling of parental smokers in the PED setting, as well as to solicit suggestions for improving the sustainability and maintenance of such practices. MethodsWe conducted an exploratory, qualitative study of a convenience sample of PED practitioners using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Individual, focused interviews were conducted to determine factors that would maximize the implementation and maintenance of parental tobacco screening and intervention counseling as standard PED practice. ResultsThirty interviews were conducted from which relevant data, patterns, and themes were identified. Reach factors included targeting parental smokers with children with respiratory diseases, having adequate training of practitioners, and providing “prearranged” counseling packages. Effectiveness factors included practitioner desire for outcome data about intervention effectiveness (eg, changes in children’s secondhand smoke exposure and parental quit rates). Solutions to increase intervention adoption included quick electronic health record prompts and the provision of onsite tobacco cessation experts. Implementation suggestions emphasized the importance of financial support and the alignment of tobacco screening/counseling with strategic plans. Maintenance factors included institutional and technical support, as well as the importance of intervention “champions” in the PED. DiscussionBy highlighting important viewpoints of practitioners regarding tobacco screening and counseling, the findings can help guide and direct the development and evaluation of sustainable interventions to facilitate tobacco use treatment in the PED.

Introduction of a tobacco-screening initiative for those at risk for bladder cancer in a high volume urology clinic.

4540 Background: Tobacco use is causal or contributory in 50% of bladder cancer diagnoses. Continued use after diagnosis may negatively impact recurrence, progression, and mortality. Despite its relevance, tobacco screening was infrequently occurring in a regional urology clinic. We hypothesized that the clinic was fertile ground for a tobacco-screening initiative given the number of referrals for bladder cancer, hematuria, and other tobacco-related urologic conditions. Methods: An EMR-based tobacco-screening prompt was designed using the same informatics architecture and clinical reporting system used in primary care. The prompt was introduced for all new patient encounters beginning January 2010. We prospectively collected the proportion of patients asked about tobacco use, advised to quit, and assisted with smoking cessation. Results: For the two years ending December 2011, 4,617 patients were seen in urologic consultation; 31% (n = 1,444) were referred for tobacco-related urologic diagnoses, 36% (n = 518) of whom were referred for bladder cancer or hematuria. The tobacco-screening prompt was used 57% (n = 2,626) of the time. Attending physicians utilized the template in 17% of their encounters, resident physicians in 71%, and nurse practitioners in 97% (p < 0.001). 49% (n = 255) of those referred for bladder cancer or hematuria were screened for tobacco use. Active smokers comprised 21% (n = 558) of screened patients. Relative to former and never smokers, active smokers were more likely referred for bladder cancer or hematuria (p = 0.005). 40% (n = 225) of active smokers desired to quit. Those counseled by an attending physician were more likely ready to quit and trended toward a more intensive cessation program (p = 0.004 and p = 0.07, respectively). Conclusions: Our data suggest that urology clinics may be important sites for tobacco-screening initiatives, particularly for those with tobacco-related urologic diagnoses. Screening patients referred for bladder cancer or hematuria is likely high yield due to the increased proportion of active smokers. Given the disparate utilization of the prompt, identification of provider-level facilitators and barriers to tobacco screening is worthy of study.

Variations in tobacco control in National Dental PBRN practices: the role of patient and practice factors

We engaged dental practices enrolled in The National Dental Practice-Based Research Network to quantify tobacco screening (ASK) and advising (ADVISE); and to identify patient and practice -characteristics associated with tobacco control. Dental practices (N = 190) distributed patient surveys that measured ASK and ADVISE. Twenty-nine percent of patients were ASKED about tobacco use during visit, 20% were identified as tobacco users, and 41% reported being ADVISED. Accounting for clustering of patients within practices, younger age and male gender were positively associated with ASK and ADVISE. Adjusting for patient age and gender, a higher proportion of non-whites in the practice, preventive services and proportion on public assistance were positively associated with ASK. Proportion of tobacco users in the practice and offering other preventive services were more strongly associated with ASK and ADVISE than other practice characteristics. Understanding variations in performance is an important step toward designing strategies for improving tobacco control in dentistry.

Addressing Tobacco Use in Homeless Populations: A Survey of Health Care Professionals

Cigarette smoking is common among homeless individuals, but little is known about health care providers' practices and attitudes in addressing tobacco use in this vulnerable population. We surveyed members of the Health Care for the Homeless Clinicians' Network, a nationwide multidisciplinary organization, to assess their tobacco screening practices, attitudes toward addressing tobacco use, and experience providing tobacco products to homeless individuals. Of 231 clinicians who completed the survey, 86.5% reported routinely screening for tobacco use. Although 74.4% of respondents viewed tobacco use as one of the most important health issues among homeless people, rates of agreement with this and other attitudes toward tobacco use in the setting of homelessness varied significantly by clinical discipline. Overall, 15.3% of respondents reported having ever given patients tobacco to build trust or promote adherence to care. Addressing providers' attitudinal variations and tobacco distribution practices may foster a more consistent anti-smoking message for this population.

Screening procedures to identify problematic substance use in medical emergency department patients

Little is known about optimal screening processes for brief intervention (BI) targeting substances other than alcohol and nicotine. An ongoing multi-site trial conducted through the National Institute on Drug Abuse-Clinical Trials Network (NIDA-CTN) investigates the effectiveness of BI for people who use drugs (with or without alcohol use) presenting to medical emergency departments (EDs). Here we describe the screening procedures and present preliminary data on the screening process and characteristics of participants enrolled in the trial. Following triage, patients are selected through ED tracking logs, and demographic information, triage level, and presenting complaint are recorded. Patients are then invited to complete screening with an instrument including four tobacco screening questions, the three consumption questions of the Alcohol Use Disorders Identification Test (AUDIT-C), and the 10-item Drug Abuse Screening Test (DAST). A DAST score of three or more plus past 30-day use of the primary problem substance are required for enrollment. During the first six months of recruitment, a total of 5713 patients were selected for possible screening; 3731 completed screening, and 343 were randomized (6% of all selected). The sample is 64% male with a mean age of 39 (± 12), and is racially and ethnically diverse. Only 2% are college graduates, 9% are married, 10% have full-time jobs, and 79% have household incomes under $15,000. The most common primary drugs of abuse were cannabis (33%, used on an average of 18 out of the past 30 days), cocaine (26%, use on and average of 9 of the past 30 days), street opioids (26%, used on an average of 19 of the past 30 days), prescription opioids (6%, used on an average of 18 of the past 30 days), and methamphetamine (6%, used on an average of 7 of the past 30 days). Six percent of those selected for screening and 9% of those screened were enrolled in the study. Baseline data indicate that the screening procedures identified people with problems in multiple life domains who had heavy use of several types of drugs.

Adapting screening, brief intervention, and referral to treatment to tobacco: a hospital trial of warm handoffs for smoking cessation

Post-discharge support is key to effective treatment for hospitalized smokers. The few hospitals that systematically address tobacco refer smokers via fax to tobacco quitlines, yet few smokers enroll. “Warm handoff” (direct referral by one provider to another provider) is used in some cases of tobacco screening and brief intervention (SBI) to link patients with treatment, but little data exists on process or outcomes. We present pilot outcomes and early implementation data on an ongoing randomized controlled trial (RCT). Recruitment began in July 1, 2011. The purpose of the trial (Enhancing Quitline Utilization by Inpatients [EQUIP]) is to determine the effectiveness and cost-effectiveness of warm handoff versus fax referral for linking hospitalized smokers with tobacco quitlines. The EQUIP trial is a two-arm RCT funded by the National Institutes of Health (trial registration: NCT01305928) in which smokers who wish to quit permanently after discharge are randomized to either fax referral (standard in-hospital intervention with fax-referral for counseling post-discharge) or warm handoff (brief in-hospital intervention and immediate staff call to the state quitline and transfer of the call to the patient’s mobile or bedside hospital phone for enrollment and an initial counseling session). Outcomes, including costs, are assessed at one, six, and 12 months following baseline. We hypothesize that warm handoff will outperform fax referral in terms of enrollment in services, cessation, and cost-effectiveness. This study explores what alcohol and other drug trials have done to strengthen handoffs and the evidence for efficacy; how EQUIP compares with AOD handoffs, and what pitfalls might be expected; and whether tobacco SBI and referral to treatment would or could be incorporated into alcohol and other drug SBI and referral to treatment.

The need for tobacco cessation in a free clinic population

IntroductionFree clinics are a unique safety net provider in that they exclusively serve the uninsured. Because free clinic providers are often volunteers, it is unclear whether uninsured patients seeking care in these clinics receive evidence-based tobacco cessation support. Here we report baseline data on prevalence and correlates of tobacco use and provider cessation advice among a sample of uninsured patients at six free clinics. MethodsPatient exit interviews were conducted after a healthcare provider visit. Logistic regression analysis was used to assess correlates of tobacco use. ResultsOf the 158 patients interviewed, 83 (53%) were tobacco users. Tobacco use was less likely among Hispanics (AOR 0.13 [95% CI 0.03–0.64]) and high school graduates (AOR=0.20 [95% CI 0.08–0.55]). Among tobacco users, 62% made at least one quit attempt in the past year and the majority were in the Contemplation (33%) or Preparation (39%) stage of readiness. 70% of all patients were screened in the past 3months, although screening was more likely among tobacco users than nonusers (AOR 3.56 [95% CI 1.47–8.61]). At the current visit, 18% of tobacco users were advised to quit and 16% were asked if they were willing to quit. ConclusionsThe prevalence of tobacco use among uninsured free clinic patients was more than twice the national average. There is substantial opportunity to increase tobacco screening among all patients and cessation advice among tobacco users. Free clinics present an untapped opportunity to reduce tobacco harm in a population at high risk for tobacco morbidity and mortality.

Reliability of Self-Reported Tobacco Use in Bipolar Disorder: An Exploratory Study of Euthymic Patients Visiting a Tertiary Care Hospital in India

Unlike schizophrenia, only a little attention has been paid to tobacco dependence in patients with bipolar disorder despite a similarly high prevalence and predisposition to health risks. The euthymic phase is especially suitable for tobacco screening by the treating psychiatrist. However, the validity of self-report for tobacco use in this patient population remains undetermined. The current study aims to assess the validity of self-reported tobacco use in euthymic bipolar disorder. The psychiatric out-patients with DSM-IV TR diagnosis of bipolar type-I in remission who were males, > or =18 years, and euthymic as established by current scores of <7 on HAM-D and <4 on YMRS. Patients were specifically asked for the recent use of tobacco in any form. Ten ml urine sample was obtained after informed consent and subjected to a quantitative cotinine estimation by direct enzyme-linked immunosorbent assay. A total of 100 patients were screened, of which 79 were finally included. The self-report for recent tobacco use showed only a moderate concordance with urinary cotinine (k = 0.518) and cotinine-creatinine ratio (k = 0.492). Over 15% patients had denied the use of tobacco, but tested positive on urinary cotinine assessment. The sensitivity of self-report was 73.3% compared to urinary cotinine. The denial among users was 26.7% and denial among those with negative self-report was 30.8%. Mental health professionals should be vigilant for detection of tobacco dependence among remitted bipolar patients, who may not be so forthcoming about their tobacco use.

Screening and Brief Intervention for Tobacco Use by Student Health Providers on College Campuses

Objective: This study assessed college students’ reports of tobacco screening and brief intervention by student health center providers. Participants: Participants were 3,800 students from 8 universities in North Carolina. Methods: Web-based survey of a stratified random sample of undergraduates. Results: Fifty-three percent reported ever visiting their student health center. Of those, 62% reported being screened for tobacco use. Logistic regression revealed screening was higher among females and smokers, compared to nonsmokers. Among students who were screened and who reported tobacco use, 50% reported being advised to quit or reduce use. Brief intervention was more likely among current daily smokers compared to current nondaily smokers, as well as at schools with higher smoking rates. Screening and brief intervention were more likely at schools with lower clinic caseloads. Conclusions: Results highlight the need to encourage college health providers to screen every patient at every visit and to provide brief intervention for tobacco users.

Implementation of a tobacco-free regulation in substance use disorder treatment facilities

We assessed the impact of a statewide tobacco-free services regulation on facility administrators' attitudes and the integration of tobacco dependence treatment into substance use disorder services. We surveyed substance use disorder treatment facility administrators in New York before (n = 285) and after (n = 205) tobacco-free services regulation implementation about their attitudes, their perceptions of staff and patient attitudes, and the facilities' services. We analyzed data on admissions and tobacco treatment pharmacotherapy administration. We found increased tobacco screening and cessation services offered, increased use of tobacco pharmacotherapy, and increased support for tobacco-free campus policies. Although patient resistance was a challenge, administrators reported a decrease in patient resistance to tobacco-free policies. Patient admissions did not decrease after the regulation went into effect. Tobacco-free services regulations in substance use disorder treatment facilities can be feasibly implemented, which has the potential to decrease the extremely high rates of tobacco use among people with substance use disorders.

Health Care Provider Tobacco Cessation Counseling Among Current African American Tobacco Users

Tobacco use is the leading cause of preventable mortality and morbidity in the United States. Patients advised to quit use of tobacco products by their health care providers are more likely to quit, yet it has been documented that patients are not receiving this advice. The aim of this study was to investigate whether or not current African American tobacco users were receiving provider-initiated advice to quit. A cross-sectional survey identified 245 self-reported African American tobacco users residing in Maryland. Study variables collected included sociodemographics, access to care, smoking status, and assessed if tobacco cessation counseling was ever provided. Among those surveyed, only 42% reported ever being counseled to quit tobacco use and, of those who had a recent clinical encounter (within the past year), only 20% reported being counseled. Multivariate logistic regression identified that having a regular source of health care, living in an urban setting, and being female increased chances of being advised to quit tobacco use. Overall, findings indicate that African Americans are not being screened or receiving cessation counseling as recommended by leading health agencies. Health care provider training to promote better integration of tobacco screening and tobacco cessation counseling during the patient encounter is needed.

The Clinical Assessment and Treatment of Nicotine Dependence

In the United States and around the world, nicotine dependence is a leading cause of preventable death. Smoking cessation results in immediate and enduring health benefits. A wide range of clinical interventions have been shown to facilitate smoking cessation and to have a favorable cost-benefit profile. Practice guidelines and national reports have issued calls to action and have made smoking cessation resources readily available. Yet utilization of smoking cessation interventions and resources is lagging. Health care systems and providers have a shared responsibility to ensure that all smokers are offered appropriate interventions. This article summarizes the epidemiology and pathophysiology of nicotine dependence as a background for reviewing the central components of clinical evidence-based smoking cessation interventions: screening, assessment, advice, assistance, and follow-up. Specific patient populations are discussed, as well as emerging strategies to address nicotine dependence.