recommendations of the United States
Preventive Services Task Force (USPSTF).^16
Another study found that while physicians knew
of their patients’ smoking status at 68 percent of
office visits, they provided smoking cessation
counseling at only 20 percent of visits by
smokers.^17 Analysis of national data found that
physicians provided counseling in 22.5 percent
of visits by current adult tobacco users; only 2.4
percent of current tobacco users were prescribed
medications for smoking cessation.* 18 A
national survey of medical professionals--
including primary care physicians, emergency
medicine physicians, psychiatrists, registered
nurses, dentists, dental hygienists and
pharmacists--indicates that whereas most report
asking patients if they smoke and advising those
who smoke to quit, they are much less likely to
follow through with assessments or referrals to a
smoking cessation program.^19
A study of physicians in family medicine,
internal medicine, obstetrics/gynecology and
psychiatry found similar results. Although most
(86 percent) report asking patients about their
smoking and advising them to quit, few do much
more than that: only 17 percent said they
usually arrange for a follow-up visit to address
the patient’s smoking and only 13 percent said
they usually refer patients who smoke to
appropriate treatment.^20 One study found that
pulmonologists, cardiologists and family
physicians were the physician specialists most
likely to be familiar with resources regarding
treatment for addiction involving nicotine and
most likely to refer patients to treatment,
whereas psychiatrists, neurologists,
ophthalmologists and surgeons were the least
likely to have such familiarity or to refer
patients.^21
A survey of clinical psychologists found that
one-third (32.3 percent) had not thought about
offering smoking cessation counseling to their
patients.^22 And although most registered nurses
ask patients about smoking (87.3 percent), only
65.6 percent advise those who smoke to quit and
- Both female patients and patients ages 65 and older
were less likely to be prescribed medication.
less than half offer interventions (49.4 percent
provide materials with quitline information and
34.0 percent refer the patient to a smoking
cessation program).^23 Another national survey
of nurses’ interventions with patients who
smoke found similar results.† 24While the U.S. Clinical Practice Guideline on
Treating Tobacco Use and Dependence
encourages dental clinicians to screen their
patients for tobacco use^25 and has been
promulgated widely by the United States Public
Health Service and the Agency for Healthcare
Research and Quality, approximately three in 10
dental professionals still do not advise patients
who smoke to quit and approximately three-
quarters do not refer a patient who smokes to a
smoking cessation program.^26 This is despite the
fact that many patients expect their dentists to
inquire about their smoking status and to discuss
smoking cessation with them; 30 percent of
dental patients report that they would try to quit
smoking if their dentist suggested they do so.^27
Dentists who implement an effective smoking
cessation intervention can expect that up to 10 to
15 percent of their patients who smoke will quit
in a given year.^28Pharmacists, as a profession, rarely provide
tobacco cessation counseling; only about seven
percent of patients report being asked by a
pharmacist about tobacco use.^29 This is in spite
of the facts that pharmacists are one of the most
accessible groups of health professionals and
they work in settings frequented by smokers and
where tobacco cessation products are available.^30
The majority of smokers (83 percent) believe
that pharmacists should be involved in providing
smoking cessation interventions, 73 percent
would join a smoking cessation program offered
at a conveniently-located pharmacy^31 and 63
percent who already use nicotine replacement
therapy (NRT) believe that smoking cessation
counseling by pharmacists would increase a† Seventy-three percent frequently asked patients
about tobacco use and 62 percent advised patients
about quitting. Only 24 percent of nurses
recommended medications to patients for cessation,
22 percent referred patients to cessation resources
and 10 percent recommended use of a quitline.