Assessment of an initial implementation of a “Ask, Advise, Refer” (AAR) tobacco cessation brief intervention in the public health clinic setting

BACKGROUND: “Ask, Advise, Refer” (AAR) is a brief cessation intervention requiring clinicians to ask patients about tobacco use, advise smokers to quit, and refer patients to tobacco cessation resources. This analysis examines the implementation of AAR in the public health clinic setting. METHODOLOGY: We surveyed 1,010 patients sequentially with a self-administered (English or Spanish) questionnaire at five public health centers within Los Angeles County in 2007. The questionnaire assessed providers' utilization of the AAR protocol and patient satisfaction with services received. RESULTS: Of 1,010 respondents, 28% were tobacco users, 52% were male, 43% were African-American, 27% Latino, 16% White, and 8% Asian. The mean age of the sample was 32 years (SD 13.0); survey response rate was 90%. The proportion of tobacco users (58% male; 55% African-American) who were asked about their smoking status, advised to quit smoking, advised on how to quit, or referred to cessation resources was 53% (146/279), 39% (108/279), 32% (88/279), and 24% (66/279), respectively. Seventy-eight percent (114/146) of tobacco users thought their providers were genuinely concerned about their tobacco use; 62% (78/108) thought the information was helpful; and 53% (146/279) thought the cessation materials were appealing. CONCLUSION: There was reasonable utilization of the AAR brief intervention and tobacco users receiving cessation services were quite satisfied. These findings suggest continued implementation of the AAR program is warranted, especially given the high levels of tobacco use found among patients in the public health clinic setting.