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Cancer Trends Progress Report – 2007 Update

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Prevention
Age at Smoking Initiation
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Quitting Smoking
Health Professionals’ Advice to Quit Smoking
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Health Professional Advice to Quit Smoking
Prevention:
Behavioral Factors

Health Professional advice to current smokers to quit smoking was rising; however, in the most recent period it may be falling.

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The Effects of Clinical Advice on Quitting Smoking

Clinicians' advice to quit smoking can by itself contribute 5 to 10 percent quit percentages among smoking patients, and much more, if coupled with behavioral therapy and pharmacological treatment of nicotine addiction. In addition, minimal clinical interventions have been shown to be cost effective in increasing smokers' motivation to quit.

If a patient wants to quit, the national guidelines suggest that the clinician should follow the "5 A's" (Ask, Advise, Assess, Assist, and Arrange). For unmotivated patients, the clinician should instead provide a motivational intervention. The Public Health Service-sponsored "Clinical Practice Guideline: Treating Tobacco Use and Dependence" expert panel's analysis suggests that a wide variety of clinicians, which would include dentists as well as physicians, can successfully implement brief strategies effectively.

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Measures

Among adult smokers (aged 18 and older) who have seen a health professional in the past 12 months, the percentage of adult smokers who report that a health professional advised them to quit smoking.

NOTE: Previous updates of the Cancer Trends Progress Report (CTPR) have shown this data separating medical doctor advice from dentist advice to stop smoking. Because the 2003 Tobacco Use Supplement to the Current Population Survey was a “Special Cessation Supplement,“ we asked several detailed questions about health professional advice to quit smoking instead of the fewer questions asking basic information about medical doctor and dentist advice separately. We will have the separate advice again for 2006–2007 and will report that in the next update in 2009. Thus we have combined the medical doctor and dentist advice from past years to indicate “any” advice from either type of doctor so that we can report trends for “health professionals” in general in this report. This is likely to slightly underestimate the 2003 value because cognitive research studies tend to indicate more affirmative responses are given when items are asked about separately (in 1992-2002 "medical doctor" and "dentist" asked about separately) than when they are combined (in 2003 asked about "medical doctor," "dentist," "nurse," and "other health professional" combined).

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Period – 1992–2003

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Trends

The percentage of smokers advised to quit shows a rise between 1993–1999 and then rises more gradually between 1999–2002, and is falling slightly between 2001–2002 and 2003. The rise until 2002 is seen for both male and female smokers, with a non-significant change for males and falling for females between 2001–2002 and 2003. In 2003, there was a slight fall to 59 percent from 61 percent of smokers receiving advice to quit from health professional.

Among 18–24-year-olds, both genders saw a rise for a shorter period (1992–1999) before showing a non-significant change and stability than for those 25 years of age and older for whom a rise was seen from 1992–2002 and then falling between 2001–2002 and 2003.

As mentioned above, the stable or slightly falling trends over the one or two most recent year estimates available may be due to a question wording change. The 2006–2007 data in the 2009 update will provide further clarification about the most recent period.

While the general trends are similar, most striking is the advice disparity between 18–24-year-old males and other gender/age categories (18–24-year-old females and those who are 25 and older of either gender). Young adult males, while showing a rise in receipt of advice to quit smoking from health professionals, are not anywhere near the level of the three other gender/age categories.

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Most Recent Estimates

In 2003, 59.8 percent of smokers 18 years of age and older (57.7 percent of males, 61.7 percent of females) who had seen a health professional during the past 12 months reported being advised by a health professional to quit smoking during the past year. In contrast to the value of about 60 percent for females 18–24 years of age (61.6 percent), and females and males 25 and older (61.7 and 59.9 percent, respectively), among 18–24-year-old males only 43.3 percent reported receiving this advice. Thus the 18–24-year-old males are advised to quit smoking at about two-thirds the rate of the other three gender/age groups.

In 2001–2002, 62 percent of smokers (60 percent of males, 63 percent of females) reported being advised by a physician to quit smoking during the past year (see 2005 CTPR update – http://progressreport.cancer.gov/2005). In contrast to physicians, the corresponding figure reporting dentists' advice was only 32 percent (33 percent of males, 30 percent of females).

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Healthy People 2010 Target

Increase the percentage of physicians and dentists and other health professionals who counsel their at-risk patients about tobacco use cessation to 85 percent.

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Groups at High Risk for Not Being Advised to Quit

The percentage of smokers advised by a medical doctor to quit increases with the age of the smoker. Consistent with the data presented in the update is a finding from a 2005 NHIS Cancer Control Supplement examination by Curry et al. (August 2007) that shows 58 percent of young adults (aged 18–24) reported being advised by a health professional to stop smoking compared with 67 percent among adults 25 years of age and older. We have seen here that this disparity is especially concerning for young adult men who are advised at a much lower rate than other gender/age categories (18–24 vs. 25 and older).

By contrast, there doesn't appear to be much change in terms of smokers' age with regard to reports of dentists' advice to quit, except for the oldest age group (65 and older), which appears to receive that advice less frequently than do younger age groups.

White non-Hispanics report the highest percentage of physician advice, followed by Black non-Hispanics and Hispanics. The re doesn't seem to be a corresponding relationship by race/ethnicity with regard to smokers' reports of dentists' advice to quit smoking.

More women had health professional advice to quit smoking (61.7 percent) as compared with men (57.7 percent).

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Key Issues

Studies show that most smokers want to quit. The success of clinicians' advice to quit and subsequent counseling increases with the intensity of the program and may be improved by increasing the frequency and duration of contact.

In addition to physicians' and dentists' advice, efforts to reduce smoking are most effective when multiple techniques are used, including educational, regulatory, and economic interventions with media campaigns and other social strategies.

While the long-term increase in both medical doctors' and dentists' advice to quit smoking is encouraging, it is clear that more progress can be made, especially for dentists. Given medical doctors', dentists' and other health professionals' combined access to 70–80 percent of smokers each year, clinicians can play a major role in smoking cessation by advising all of their smoking patients to quit.

Progress needs to be made in removing barriers to clinicians in providing advice and further treatment, as well as barriers to patients in seeking treatment. An important barrier to both groups is lack of medical insurance coverage that includes counseling and pharmacological treatment for smoking cessation.

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Links to Additional Information on Health Professionals' Advice to Quit Smoking

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