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

Disclosures

BMC Public Health. 2016;16(141) 

In This Article

Methods

Data Source

The 2009–2010 National Adult Tobacco Survey (NATS) was a stratified, national landline and mobile phone survey of noninstitutionalized civilian adults aged 18 years or older residing in the 50 U.S. states and the District of Columbia. The study design has been described in detail elsewhere[10] and the data used for the study is openly available. Respondent selection varied by phone type. For landline numbers, one adult was randomly selected from each eligible household. In contrast, adults who only used mobile phones were selected through screening of a sample of mobile phone numbers. In total, 118,581 NATS interviews were completed (landline n = 110,634, mobile phone n = 7,947) in both English and Spanish from October 20, 2009 to February 28, 2010. The national Council of American Survey and Research Organizations response rate, or the number of completed interviews divided by the number of eligible respondents in the sample, was 37.6 % (landline = 40.4 %, mobile phone = 24.9 %).[11] The national cooperation rate, or the number of completed interviews divided by the number of eligible respondents who were successfully reached by an interviewer, was 62.3 % (landline = 61.9 %, mobile phone = 68.7 %).

Of the 118,581 respondents who completed interviews, a total of 105,896 respondents reported seeing a health care provider in the past year (Fig. 1). Of these, 10,801 were current cigarette-only smokers who had seen a health professional in the past 12 months and who provided complete demographic information (sex, age, race/ethnicity, and education). These 10,801 current cigarette smokers served as our study sample and were asked questions related to provider delivery of the 5 A's: Ask, Advise, Assess, Assist, and Arrange (Appendix) and are presented in the standard 5 A's order.

Figure 1.

Schematic of participant inclusion and exclusion—National Adult Tobacco Survey, 2009–2010

Measures

Smoking Status. Cigarette smoking status was assessed using two standard questions. The first question was, "Have you smoked at least 100 cigarettes in your entire life?" Those who responded yes were then asked, "Do you now smoke cigarettes every day, some days, or not at all?" Respondents who stated that they currently smoked every day or some days were considered to be a current cigarette smoker. The study assessed current smokers who did not use any other tobacco products (cigarette-only smokers).

Receipt of Brief Cessation Interventions. To determine whether respondents visited a health professional, adults who smoked were asked, "In the past 12 months, have you seen a doctor, dentist, nurse, or other health professional?" Cigarette-only smokers who had visited a health professional in the past 12 months were asked about receipt of all of the 5 A's from their health professional. To determine if a health professional 'Asked' about tobacco use, respondents were asked, "In the past 12 months, did any doctor, dentist, nurse, or other health professional ask if you smoke cigarettes or use any other tobacco products?" To determine if a health professional 'Advised' them to quit, respondents were asked, "In the past 12 months, did any doctor, dentist, nurse, or other health professional advise you to quit smoking cigarettes or using any other tobacco products?" To determine if a health professional 'Assessed' willingness to make a quit attempt, respondents were asked, "The last time a health professional advised you to quit using tobacco, did they also ask if you wanted to try to quit?" To determine if a health professional 'Assisted' respondents in quitting, they were asked, "The last time a health professional advised you to quit using tobacco, did they also offer any assistance, information, or additional advice to help you quit?" To determine if a health professional 'Arranged' or scheduled a follow-up contact, they were asked, "(Did they) schedule any follow-up contacts, either in person or by phone, or arrange for someone else to call you to see how your quit attempt was going?" Response options for each question were yes, no, don't know/not sure, or refused.

Based on the skip pattern used in the NATS, not all smokers were asked about receipt of all of the 5 A's. The NATS questionnaire first queried smokers regarding whether they were 'Advised' to quit. A total of 7,324 smokers reported that they received such advice (n = 3,477 were not advised or missing). The NATS survey followed with a question on 'Asked' (asking about tobacco use) which was queried of the 3,477 who responded no to the 'Advised' question. Of these, 2, 196 reported that they were 'Asked' and 1,281 were not asked or were missing. Because we assumed that only smokers were 'Advised' to quit, those who reported yes to the Advised question were recoded as responding yes to the 'Asked' question. This resulted in an estimated 9,520 (7,324 + 2,196) respondents reporting that they were 'Asked' about their tobacco use. Among the 7,324 who were 'Advised' to quit, a total of 4,787 reported yes to the 'Assessed' question (asking about willingness to quit). Those who were 'Advised' were also asked the 'Assist' question (asked if received assistance with quitting); 4,356 respondents reported that they were 'Assisted' with quitting. Those who were 'Assisted' were then asked the 'Arrange' question (asked if follow-up was arranged); 642 responded yes to the 'Arrange' question. On the NATS, the actual word order for the 5 A's were: Advised, Asked, Assessed, Assisted, and Arranged; however, we present findings in the standard 5 A's order (Fig. 1). To assess self-reported delivery of the 5 A's, we limited the scope to cigarette-only smokers who saw a health professional in the past 12 months to examine patient-reported receipt of the 5 A intervention among those eligible. We used the same denominator (n = 10,801) for each of the 5 A items.

Receipt of Specific "Assisted" Interventions. Respondents who said they had been offered assistance ('Assist') were also asked about the provision of specific forms of assistance: "The last time a health professional advised you to quit using tobacco, did they provide you with booklets, videos, website addresses, or other information to help you quit?"; "Did they put you in contact with, or tell you how to contact, a telephone quitline, a class or program, or one-on-one counseling?"; "(Did they) recommend or prescribe a nicotine patch, nicotine gum, lozenges, nasal spray, an inhaler, or pills such as Wellbutrin, Zyban, Bupropion, Chantix, or Varenicline?"; and "Did they help you set a specific date to quit using tobacco products?"

Cessation Treatment use. Respondents were asked four questions about their use of cessation resources to help them quit: "Did you call a telephone quitline?"; "Did you use a class or program to help you quit?"; "Did you use one-on-one counseling from a health professional to help you quit?"; and "Did you use any of the following medications: a nicotine patch, nicotine gum, nicotine lozenges, nicotine nasal spray, a nicotine inhaler, or pills such as Wellbutrin, Zyban, Bupropion, Chantix, or Varenicline to help you quit?" Those who answered yes to one of these questions were identified as having used that cessation treatment. Respondents who reported calling a telephone quitline, using a class or a program, or using one-on-one counseling were aggregated into a single 'counseling' variable. Respondents who reported using any of the medications were classified as using medication. Respondents who reported using 'counseling' and any cessation medication were classified as using the combination of counseling and medication.

Respondent Characteristics. The following respondent characteristics were included in the analysis: sex, age (18–24, 25–34, 35–54, or ≥55 years), race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, or non-Hispanic other), and education (less than high school, high school diploma, some college, college educated). The race/ethnicity 'non-Hispanic other' category included respondents who were American Indian or Alaska Native, Native Hawaiian or Pacific Islander, Asian, multiracial, or some other race.

Statistical Analysis

Descriptive analyses were conducted overall and among current cigarette-only smokers by sex, age, race/ethnicity, and educational attainment. We estimated the prevalence of using counseling, medication, or a combination of counseling and medication by receipt of the 5 A's and demographic characteristics. We conducted multivariate logistic regression analyses to estimate the association between receipt of the 5 A's and use of cessation services (counseling, medication, or combination of counseling and medication) while adjusting for sex, age, race/ethnicity, and educational attainment. Three separate logistic regression models were constructed with use of each of the cessation services as the dependent variable, and receipt of 5 A's and demographic variables as the independent variables. Odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated. SAS-callable SUDAAN (version 9.2; Research Triangle Institute, Research Triangle Park, NC) was used to accommodate the complex sampling design. Landline data were weighted according to the selection probability of the telephone number, the number of adults in the household, and the number of landline telephone numbers in the household. Mobile phone data were weighted only according to the selection probability of the mobile phone number because a mobile phone was assumed to be used only by the person who answered.[12]

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