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Cancer Trends Progress Report – 2011/2012 Update

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In the Report
Introduction
Trends-at-a-Glance
Summary Tables
Prevention
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
Fat Consumption
Alcohol Consumption
Physical Activity
Weight
Sun Protection
Secondhand Smoke
Pesticides
Dioxins
Tobacco Company Marketing Expenditures
Early Detection
Diagnosis
Treatment
Life After Cancer
End of Life



Clinicians’ Advice to Quit Smoking
Prevention: Behavioral Factors

Clinicians’ advice to current smokers to quit smoking has begun to stabilize and in some cases decline.

On this page:

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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Measure

Among adult smokers (aged 18 years and older) who have seen a physician 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 – 1992–2010

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Trends

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. Percentages remained steady from 2007 to 2010 for both males and females.

For smokers aged 25 years and older, both males and females had a rise in receiving advice to quit throughout the entire period from 1992 to 2007, but percentages changed little from 2007 to 2010. For young adult smokers aged 18 to 24 years, 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.

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, although women aged 25 years and older did not show much change between 2002 and 2007. However, from 2007 to 2010, the percentage of men and women receiving dentists’ advice to quit smoking declined. Both men and women aged 18 to 24 years showed increases early in the 1990s but then showed no significant change throughout the rest of the period studied.

The trend in the percentage of adults who were advised to quit smoking by a physician varied by race/ethnicity. Overall there was a rise between 1992 and 2010 for all race/ethnicity groups. Over the recent decade (2001–2010), the trend has been stable for non-Hispanic whites, while it has risen for non-Hispanic blacks and Hispanics. Although overall, there has been an increase in dentist advice reported by non-Hispanic whites and non-Hispanic blacks, this is not seen for Hispanics. Over the recent decade, all three race/ethnicity groups showed no significant change. However, from 2007–2010, the percentage of smokers receiving dental advice to quit decreased for non-Hispanic whites and Hispanics, while non-Hispanic blacks showed no significant change. Non-Hispanic whites showed a steeper decline than non-Hispanic blacks. For the same time period, the percentage of adult smokers aged 25 years and older with less than high school education who received dentists’ advice changed little, while the percentages of adult smokers with high school education or greater than high school education who received dentists’ advice decreased. The percentage of smokers with incomes greater than or equal to 200 percent of the federal poverty level who received dentists’ advice to quit decreased from 2007 to 2010, while the percentage of those with incomes less than 200 percent of the federal poverty level remained stable.

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Most Recent Estimates

In 2010, 64.4 percent of smokers aged 18 years and older (63.0 percent of males, 65.7 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 to 24 years, the percentages were 58.4 and 41.8, respectively. Among smokers aged 25 years and older, 66.6 percent of females and 66.0 percent of males were advised by a physician to quit smoking.  

In contrast, the 2010 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 and older, only 29.8 percent received advice to quit from a dentist (32.1 percent of males and 27.8 percent of females). Among those aged 18 to 24 years, 35.3 percent of males and 33.0 percent of females received advice to quit from a dentist. Among those aged 25 years and older, 31.7 percent of males and 26.6 percent of females received advice to quit from a dentist.

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Healthy People 2020 Targets

The Healthy People 2020 (HP2020) targets are developed based on the National Center for Health Statistics survey of physicians and hospitals. In contrast, the data presented in the Cancer Trends Progress Report are based on reports from patients regarding whether they received smoking cessation advice from their physicians or dentists. Therefore, the data presented in this report cannot be directly compared with the HP2020 objectives. Nevertheless, patient self-report data is a valuable measure of how clinicians’ advice to quit smoking is changing over time.

HP2020 includes targets for physicians’ advice to quit smoking in office-based ambulatory care settings and in hospital ambulatory care settings. In 2007, 19.2 percent of visits to physicians’ offices by smokers aged 18 and older had tobacco cessation counseling ordered or provided. The HP2020 objective is to reach 21.1 percent of visits, a 10 percent increase. The HP2020 target for ordered or provided tobacco cessation counseling during hospital visits is 24.9 percent of visits, a 10 percent increase from the 2007 baseline of 22.6 percent. Healthy People 2020 targets for dentists’ advice to quit smoking are still in development.

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Groups at High Risk for Not Being Advised to Quit

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

By contrast, females aged 25 years and older had the lowest rate of advice from dentists among the four age/gender groups. In 2010, this was about 27 percent for females aged 25 years and older versus 32 to 35 percent for the other three age/gender groups.

In 2010, non-Hispanic whites reported the highest percentage of receiving physicians’ advice (65.2 percent), followed by non-Hispanic blacks (62.6 percent), and Hispanics (59.7 percent).

In 2010, Hispanics reported the lowest percentage of receiving dentists’ advice (25.0 percent) compared with non-Hispanic whites (29.9 percent) and non-Hispanic blacks (31.5 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, as well as media campaigns and other social strategies.

Although the long-term increase in both physicians’ and dentists’ advice to quit smoking is encouraging, the more recent stall and decline, respectively, is clear evidence 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 has been lack of medical insurance coverage for counseling and pharmacological treatment for tobacco dependence. This barrier has already been reduced and will be further reduced in the future with the implementation of the 2010 Patient Protection and Affordable Care Act. The act provides tobacco cessation coverage through some Medicaid provisions and also through those provisions pertaining to non-grandfathered private health plans.

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Additional Information on Clinicians' Advice to Quit Smoking

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Back: Quitting Smoking

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