Tobacco use screening and counseling during physician office visits among adults--National Ambulatory Medical Care Survey and National Health Interview Survey, United States, 2005-2009

Abstract

Tobacco use continues to be the leading cause of preventable disease and death in the United States; cigarette smoking accounts for approximately 443,000 premature deaths annually. In 2009, the prevalence of smoking among U.S. adults was 20.6% (46 million smokers), with no significant change since 2005 (20.9%). In 2010, approximately 69% of smokers in the United States reported that they wanted to quit smoking. Approximately 44% reported that they tried to quit in the past year for ≥1 day; however, only 4%-7% were successful each year. Tobacco dependence has many features of a chronic disease: most patients do not achieve abstinence after their first attempt to quit, they have periods of relapse, and they often require repeated cessation interventions. At least 70% of smokers visit a physician each year, and other smokers visit other health-care professionals, providing key opportunities for intervention. The 2008 update to the U.S. Public Health Service (PHS) Clinical Practice Guideline: Treating Tobacco Use and Dependence recommends that clinicians and health-care delivery systems consistently identify and document tobacco use status and treat every tobacco user seen in a health-care setting using the 5 A's model: 1) ask about tobacco use, 2) advise tobacco users to quit, 3) assess willingness to make a quit attempt, 4) assist in quit attempt, and 5) arrange for follow-up. The PHS guideline also recommends the following as effective methods for increasing successful cessation attempts: individual, group, and telephone counseling; any of the seven first-line medications for tobacco dependence that are approved by the Food and Drug Administration (FDA); and provision of coverage for these treatments by health-care systems, insurers, and purchasers. However, clinicians and health-care systems often do not screen for and treat tobacco use consistently and effectively.