Receipt of Evidence-based Brief Cessation Interventions by Health Professionals and use of Cessation Assisted Treatments Among Current Adult Cigarette-only Smokers: National Adult Tobacco Survey, 2009–2010

Judy Kruger; Alissa O'Halloran; Abby C. Rosenthal; Stephen D. Babb; Michael C. Fiore


BMC Public Health. 2016;16(141) 

In This Article


In the United States, approximately 480,000 people die from a smoking-related illness each year.[1] Smoking cessation can significantly reduce the risk of developing smoking-related diseases and increase life expectancy.[1,2] A United States Public Health Service (USPHS) Clinical Practice Guideline emphasizes the importance of health professionals providing tobacco dependence treatment to their patients.[3] The Guideline recommends that health professionals follow a brief, evidence-based cessation intervention known as the '5 A's': Ask about tobacco use, Advise tobacco users to quit, Assess willingness to make a quit attempt, Assist tobacco users in making a quit attempt, and Arrange for follow-up. The Guideline also notes that tobacco dependence treatments are highly cost-effective.[3–5] Although effective clinical interventions exist, patient-reported data suggest that health professionals do not consistently deliver evidence-based cessation treatments to patients who smoke.[3,6]

Quitting smoking is difficult and often requires multiple quit attempts, so it is important for health professionals to repeatedly address cessation with their patients who smoke.[7] As part of the 5 A's, the USPHS Clinical Practice Guideline recommends that health professionals routinely provide brief counseling and recommend medications (unless contraindicated) for tobacco cessation. Although the combination of counseling and medication is more effective for smoking cessation than either counseling or medication alone, smokers' use of this combined approach is limited.[8,9] Collectively, these data underscore the importance of health professionals and the health systems in which they work, to deliver all five of the 5 A's at every clinic visit.[3]

Health professionals have frequent contact with their patients, have high credibility, and play an important role in educating their patients about the consequences of smoking.[3,7] However, no recent studies have examined the extent to which patients actually use cessation treatments recommended during the medical encounter. While reports suggest delivery of the 5 A's intervention yields greater patient use of cessation services, many health professionals do not routinely provide all of these components.[7] Thus, more in-depth information on patient-reported receipt of the 5 A's and how this affects patients' use of cessation assisted treatments may help guide efforts to increase health professionals' delivery of all components of this evidence-based intervention. To address this gap in the literature, this study assessed the association between smokers' self-reported receipt of the 5 A's and use of cessation assisted treatments, including the optimal recommended combination of counseling and medication.