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.
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.
Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, 3005 Chamblee Tucker Rd., Atlanta, GA 30341, USA. jze1@cdc.gov
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D000293:Adolescent; D000328:Adult; D000368:Aged; D044383:Black People / Q000706:statistics & numerical data; D003376:Counseling / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D010045:Outpatients; D010353:Patient Education as Topic; D010818:Practice Patterns, Physicians'; D016540:Smoking Cessation / Q000706:statistics & numerical data; D061485:Tobacco Use Cessation Devices / Q000706:statistics & numerical data*; D014029:Tobacco Use Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology / Q000628:therapy*; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult; D001741:Black or African American