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Cancer Trends Progress Report – 2009/2010 Update

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Age at Smoking Initiation
Youth Smoking
Adult Smoking
Quitting Smoking
> Clinicians’ Advice to Quit Smoking
Medicaid Coverage of Tobacco Dependence Treatments
Fruit and Vegetable Consumption
Red Meat Consumption
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Secondhand Smoke
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Clinicians’ Advice to Quit Smoking
Prevention: Behavioral Factors

Clinicians’ advice to current smokers to quit smoking continues to rise.

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The Effects of Clinical Advice on Quitting Smoking

Clinicians' advice to quit smoking can by itself contribute 5 to 10 percentage points toward quitting 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 recommend that the clinician follow the "5 A's" (Ask, Advise, Assess, Assist, and Arrange). For patients who do not want to quit, the clinician should instead provide a motivational intervention. The Public Health Service-sponsored "Clinical Practice Guideline: Treating Tobacco Use and Dependence 2008 update” expert panel's analysis suggests that a wide variety of clinicians, including dentists, physicians, and other health professionals, can successfully implement brief strategies effectively.

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

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Period – 1992–2007

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The percentage of smokers advised by a physician to quit shows a steep rise from 1993 to 1999 and then a more gradual rise from 1999 to 2007. The rise for each period of time is similar for both males and females. 

For smokers aged 25 years and older, both males and females had a rise in receiving advice to quit through the entire period 1992 to 2007. The period from 2001 to 2007 shows a shallower rise; however, the pattern for young adults aged 18 to 24 years is less positive. Only the early part of the period prior to 1999 showed any rise. Since 1999, the percentage receiving advice to quit from a physician has changed little. While the trend is similar for both adult men and women, the percentage of young adult men receiving advice to quit is much lower than that for young women, older men, and older women.

Similar to the results for physicians’ advice to quit smoking, both male and female smokers tended to show rises in receipt of advice from dentists to quit smoking over most of the time period studied. However, women did not show much change between 2002 and 2007, especially among those aged 25 years and older. Both men and women aged 18–24 years showed increases from 1999 to 2007.

The percentage of adults who were advised to quit smoking by either a physician or a dentist during the past year did not vary by race/ethnicity, education level, or poverty status.

Download: data (Excel) | image (JPEG)

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Download: data (Excel) | image (JPEG)

Download: data (Excel) | image (JPEG)

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Most Recent Estimates

In 2006 to 2007, 65.1 percent of smokers aged 18 years and older (63.8 percent of males, 66.0 percent of females) who had seen a physician during the past 12 months reported being advised by that physician to quit smoking. For females and males aged 18–24 years, the percentages were 63.1 and 43.1 respectively. Among smokers aged 25 years or older, 79.6 percent of females and 73.7 percent of males were advised by a physician to quit smoking.  

In contrast, the 2006 to 2007 estimates for receipt of advice from a dentist to quit smoking were much lower than the comparable estimates for receipt of advice from a physician. For those aged 18 years or older, only 33.6 percent received advice to quit from a dentist (36.9 percent of males and 30.7 percent of females). Among those aged 18–24 years, 37.7 percent of males and 36.5 percent of females received advice to quit from a dentist. Among those aged 25 years or older, 36.7 percent of males and 29.7 percent of females received advice to quit from a dentist.

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Healthy People 2010 Target

Increase the percentage of physicians, 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

Young adult males aged 18–24 years are far less likely to receive advice to quit from their physician than older men or women aged 18–24 and 25+ years.

By contrast, females aged 25 years and older had the lowest rate of advice from dentists among the four age/gender groups. In 2006 to 2007 this was about 30 percent for females aged 25 years or older versus 37 to 38 percent for the other three age/gender groups.

In 2006 to 2007, non-Hispanic Whites report the highest percentage of receiving physician advice (65.7 percent), followed by Hispanics (63.2 percent) and non-Hispanic Blacks (60.9 percent). By contrast, the three race/ethnicity groups are more closely clustered for receipt of advice from a dentist.  

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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, as well as media campaigns and other social strategies.

While the long-term increase in both physicians’ and dentists' advice to quit smoking is encouraging, it is clear that improvement is still needed, especially for dentists. Given physicians’, dentists', and other health professionals' combined access to 70 to 80 percent of smokers each year, clinicians can play a major role in smoking cessation by advising all of their patients who smoke to quit.

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

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Additional Information on Clinicians' Advice to Quit Smoking

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Back: Quitting Smoking

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