Background: This study sought to determine the availability of tobacco cessation services in free clinics.
Methods: In fall 2007, a survey was e-mailed to free clinics that asked respondents to indicate the availability of13 different services recommended as part of the Treating Tobacco Use and Dependence guidelines set by the United States Public Health Service (USPHS). Seventy-two percent (n=51) of clinics responded to the survey.
Results: The majority of clinics enforce a "no tobacco use" policy inside the clinic (98%), encourage health care providers to advise patients to quit (90%), ask patients about tobacco use behavior on intake (78%), provide self-help materials (70%), and offer pharmacotherapy (e.g., bupropion) for quitting (60%). Fewer clinics offer fee nicotine replacement therapy (35%), display counter-advertisements in waiting areas and patient rooms (35%), have a designated staff person or volunteer to help patients quit (26%), evaluate whether health care providers offer tobacco cessation advice (30%), or have onsite tobacco cessation classes (22%). One out of 3 free clinics offer comprehensive (at least 9 of 13) tobacco cessation services using the USPHS Treating Tobacco Use and Dependence guidelines.
Limitations: Small sample size limits analytical techniques that can be applied, as well as interpretation of results.
Conclusion: Free clinics offer an excellent opportunity to reach the uninsured population for tobacco cessation. Although 1 in 3 clinics is comprehensive in its approach to reduce tobacco use among their patients, many have yet to undertake the breadth of clinic-based strategies that can promote quitting. This study serves as an opportunity and a challenge to free clinics to expand their service delivery into the area of behavioral health.