title: Effectiveness of the 5-As tobacco cessation treatments in nine HMOs.
abstract: BACKGROUND
  Smoking remains the leading cause of preventable mortality in the US. The national clinical guideline recommends an intervention for tobacco use known as the 5-As (Ask, Advise, Assess, Assist, and Arrange). Little is known about the model's effectiveness outside the research setting.
  
  
  OBJECTIVE
  To assess the effectiveness of tobacco treatments in HMOs.
  
  
  METHODS
  Smokers identified from primary care visits in nine nonprofit health plans.
  
  
  METHODS
  Smokers were surveyed at baseline and at 12-month follow-up to assess smoking status and tobacco treatments offered by clinicians and used by smokers.
  
  
  RESULTS
  Analyses include the 80% of respondents who reported having had a visit in the previous year with their clinician when they were smoking (n = 2,325). Smokers were more often offered Advice (77%) than the more effective Assist treatments-classes/counseling (41%) and pharmacotherapy (33%). One third of smokers reported using pharmacotherapy, but only 16% used classes or counseling. At follow-up, 8.9% were abstinent for >30 days. Smokers who reported being offered pharmacotherapy were more likely to quit than those who did not (adjusted OR = 1.73, CI = 1.22-2.45). Compared with smokers who didn't use classes/counseling or pharmacotherapy, those who did use these services were more likely to quit (adjusted OR = 1.82, CI = 1.16-2.86 and OR = 2.23, CI = 1.56-3.20, respectively).
  
  
  CONCLUSIONS
  Smokers were more likely to report quitting if they were offered cessation medications or if they used either medications or counseling. Results are similar to findings from clinical trials and highlight the need for clinicians and health plans to provide more than just advice to quit.
authors.affiliation: Research & Evaluation Department, Kaiser Permanente Southern California, 100 So. Los Robles Ave, 2nd Fl., Pasadena, CA 91188, USA. virginia.p.quinn@kp.org
authors.forename: Virginia P
authors.initials: VP
authors.lastname: Quinn
authors.forename: Jack F
authors.initials: JF
authors.lastname: Hollis
authors.forename: K Sabina
authors.initials: KS
authors.lastname: Smith
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Rigotti
authors.forename: Leif I
authors.initials: LI
authors.lastname: Solberg
authors.forename: Weiming
authors.initials: W
authors.lastname: Hu
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Stevens
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome