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Assessing smoking-cessation programs – Does the 5A program work?


Cigarette smoking continues to be the principal cause of premature death in the nation and a major cause of medical expenditures and lost productivity. Of the 46.5 million adults in the United States who smoke, about 70% will see a primary care provider at least once a year. The United States Public Health Service (USPHS), in an effort to reduce cigarette smoking, recommends a 5-step process that includes: (1) Asking every patient about tobacco use, (2) Advising all smokers to quit, (3) Assessing smokers’ willingness to make a quit-attempt, (4) Assisting smokers with treatment and referrals, and (5) Arranging follow-up contacts. Does this "5A" program work?

A study published in the August issue of the American Journal of Preventive Medicine provides the most comprehensive assessment yet available on the delivery of smoking cessation services recommended by the USPHS clinical practice guideline for tobacco. Results demonstrate substantial clinician compliance with the guideline and highlight areas in need of improvement. In contrast to commonly-held beliefs, smokers reported they wanted their doctors to discuss cessation at most medical visits, and were more satisfied with their health plan when they received help with quitting.

Researchers from 7 organizations across the United States, including managed healthcare providers, health research centers and medical schools, evaluated the results of a survey mailed to almost 65,000 participants in 9 non-profit Health Maintenance Organizations. There was a 70% response rate to the survey and about 10% of the respondents were smokers. From this sample of about 4200 smokers, the extent of compliance with the "5A" treatment model was measured.

Although most smokers were asked about smoking (90%) and more than two-thirds (71%) were advised to quit, only about half were assessed for their willingness to quit (56%) and given assistance for quitting (49%). Arrangements for follow-up were only provided to 9% of the smokers. Looking deeper, smokers who asked for help were more likely to receive advice (81%) and assistance (81%) than smokers who did not ask (67% and 37%, respectively). In addition, smokers who received more of the 5A’s were more satisfied with their health maintenance organizations.

Writing in the article, Virginia P. Quinn, PhD, states, "The strongest predictor of these cessation services was a request for help…This is of concern since only 27% of smokers in this study asked for help, and even among the presumably more motivated smokers planning to quit, only a third requested help. Limiting tobacco treatment to smokers who ask for help overlooks many who are interested in quitting, but are unaware of the services available from their health providers…Effective tobacco control, however, requires offering cessation services to all smokers. Even light smoking carries substantial health risks, and lighter smokers may be less aware of this danger."

While there was substantial compliance with the USPHS clinical guideline for treating tobacco dependence, there is still room for improvement. Dr. Quinn continues, "Health plans may be able to increase the effectiveness of their tobacco control efforts by encouraging smokers to ask their physicians for help. Importantly, smokers expect to receive the 5As cessation treatments and are more satisfied with health plan services when clinicians comply with the national guideline. This should provide encouragement to physicians to treat smokers and an incentive to healthcare organizations to support delivery of tobacco-cessation services."

Charlotte Seidman | EurekAlert!
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