Expanding providers' smoking cessation services: A national survey of US health professionals

BACKGROUND: Primary care physicians have been the main focus for smoking cessation efforts, but alone provide insufficient support. The smoking behavior and cessation practices and barriers of other health professionals have not been reported. METHOD: The study included 2804 subjects from 7 health professional groups who serve as an initial point of health care system contact for smokers: primary care physicians, emergency medicine physicians, psychiatrists, registered nurses, dentists, dental hygienists, and pharmacists. The survey was conducted nationwide from 2003-2004, primarily by telephone and supplemented by mailed questionnaires. Outcomes included self-reported smoking status, smoking cessation practices and barriers. We also examined factors associated with a simplified version of current smoking cessation guidelines: “ask, advise, and refer.” RESULTS: Health professionals have a low smoking prevalence (<6%), except for nurses (13%). Many health professionals report asking (50.5-88.1%) and advising (65.6-94.9%) about smoking, but much less assessing smokers' interest (38.7-84.8%), assisting with quit dates (16.4-63.7%), and arranging follow-up (1.3-23.1%). The greatest barriers to providing smoking cessation services are patient attributes and practice issues. Controlling for patient and practice demographics, factors significantly associated with “ask, advise, and refer” include cessation training and professionalism, while negative associations include current smoking status. CONCLUSIONS: Health professionals are not fully implementing smoking cessation guidelines. With practice issues cited as a key barrier, health professionals should consider to “ask, advise, and refer,” if assessing, assisting, and arranging follow-up is not feasible. The education, professionalism, and personal smoking cessation of health professionals are important to expand providers' smoking cessation services.