title: Clinician advice to quit smoking among seniors.
abstract: OBJECTIVE
  Little smoking research in the past 20years includes persons 50 and older; herein we describe patterns of clinician cessation advice to US seniors, including variation by Medicare beneficiary characteristics.
  
  
  METHODS
  In 2012-4, we analyzed 2010 Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data from Medicare beneficiaries over age 64 (n=346,674). We estimated smoking rates and the proportion of smokers whose clinicians encouraged cessation.
  
  
  RESULTS
  12% of male and 8% of female respondents aged 65 and older smoke. The rate decreases with age (14% of 65-69, 3% of 85+) and education (12-15% with no high school degree, 5-6% with BA+). Rates are highest among American Indian/Alaskan Native (16%), multiracial (14%), and African-American (13%) seniors, and in the Southeast (14%). Only 51% of smokers say they receive cessation advice "always" or "usually" at doctor visits, with advice more often given to the young, those in low-smoking regions, Asians, and women. For all results cited p<0.05.
  
  
  CONCLUSIONS
  Smoking cessation advice to seniors is variable. Providers may focus on groups or areas in which smoking is less common or when they are most comfortable giving advice. More consistent interventions are needed, including cessation advice from clinicians.
authors.affiliation: RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA. Electronic address: shadel@rand.org.
authors.forename: William G
authors.initials: WG
authors.lastname: Shadel
authors.affiliation: RAND Corporation, 1776 Main St., PO Box 2138, Santa Monica, CA 90407-2138, USA. Electronic address: elliott@rand.org.
authors.forename: Marc N
authors.initials: MN
authors.lastname: Elliott
authors.affiliation: RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA. Electronic address: ahaas@rand.org.
authors.forename: Ann C
authors.initials: AC
authors.lastname: Haas
authors.affiliation: RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA; H. John Heinz III College, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA 15213, USA. Electronic address: haviland@cmu.edu.
authors.forename: Amelia M
authors.initials: AM
authors.lastname: Haviland
authors.affiliation: RAND Corporation, 1776 Main St., PO Box 2138, Santa Monica, CA 90407-2138, USA. Electronic address: orr@rand.org.
authors.forename: Nate
authors.initials: N
authors.lastname: Orr
authors.affiliation: Veteran's Administration HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 16111 Plummer Street (152), Sepulveda, CA 91343, USA. Electronic address: Melissa.Farmer@va.gov.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Farmer
authors.affiliation: Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, MD 21244, USA. Electronic address: sai.ma@cms.hhs.gov.
authors.forename: Sai
authors.initials: S
authors.lastname: Ma
authors.affiliation: Dept. of Health Services Administration, University of Alabama, Birmingham, 1720 2nd Avenue South, SHPB 558, Birmingham, AL 35294, USA. Electronic address: rweech@uab.edu.
authors.forename: Robert
authors.initials: R
authors.lastname: Weech-Maldonado
authors.affiliation: RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA. Electronic address: farley@rand.org.
authors.forename: Donna O
authors.initials: DO
authors.lastname: Farley
authors.affiliation: Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT 06520-8034, USA. Electronic address: paul.cleary@yale.edu.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Cleary
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D004522:Educational Status; D005260:Female; D005843:Geography; D019538:Health Care Surveys; D006304:Health Status; D006801:Humans; D016014:Linear Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D054525:Minority Health / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000379:methods / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology* / Q000208:ethnology; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D000074606:Smoking Prevention; D014481:United States
keywords: Medicare; Patient education; Physician/patient communication; Smoking cessation