Healthcare Providers Should Offer Smoking-Cessation Advice More Often

Laurie Barclay, MD

July 20, 2007 — Healthcare providers should offer smoking-cessation advice more often, according to the results of a 2005 Canadian survey reported in the July 20 issue of the Morbidity and Mortality Weekly Report. Only half of persons in that survey who visited healthcare providers in the preceding 12 months reported receiving smoking-cessation advice, suggesting that healthcare professionals may be missing valuable opportunities to educate their patients about how to quit smoking.
"Tobacco use is the most preventable cause of premature death and disease in Canada," write J. Stevenson, from the Tobacco Control Programme, Health Canada, and colleagues. "One of the objectives of the Canadian Federal Tobacco Control Strategy (FTCS) 2001–2011 is to reduce smoking prevalence in Canada from 25% to 20%. Although evidence indicates that an effective and efficient way of providing smoking-cessation information to smokers is through contact with health-care providers little data in Canada exist regarding smoking-cessation advice from this group."
During February to December 2005, the Canadian Tobacco Use Monitoring Survey collected data from approximately 20,800 respondents. The survey contained questions about provision of smoking-cessation advice by healthcare professionals, including physicians, dentists or dental hygienists, and pharmacists, in the 12 months before the survey.
Of the current smokers who had visited a physician in the preceding 12 months, 51% reported that they were advised at that visit to reduce or to stop smoking. Only 38% of the youngest smokers (aged 15–19 years) received smoking-cessation advice, but this rate increased with increasing age. In the 20- to 24-year age group, 33% of males and 50% of females were advised by a physician to reduce or quit smoking
For healthcare professionals other than physicians, about 36% of survey respondents were advised to reduce or stop smoking by dentists or dental hygienists, and about 16% received this advice from pharmacists.
"Although 88% of current smokers in Canada reported visiting a health-care provider in the preceding 12 months, only half of these smokers reported being advised to reduce or quit smoking," an accompanying editorial note points out. "Health-care providers are in a unique position to offer smoking-cessation advice and provide information on smoking-cessation aids to their patients; however, the results of this analysis indicate that many of these opportunities are being missed."
Study limitations include failure to sample households without landline telephones; lack of data on the frequency, timing, and nature of respondent visits to healthcare providers or healthcare provider advice; lack of data on whether the respondents told their healthcare providers that they smoked; reliance on self-report, which is subject to social desirability bias or recall bias; inability to make causal inferences from cross-sectional data; and possible underestimates of healthcare provider provision of smoking-cessation advice.
"A smoker's chance of quitting increases after receiving smoking-cessation information and support from various health-care providers in different disciplines," the editorial concludes. "Although certain health-care providers have included smoking-cessation activities in their practices, the results indicate that either many health professionals are missing this opportunity to provide smoking-cessation advice or that smokers are not seeking this advice from their health-care providers. Practice guidelines to identify smokers and encourage cessation could help increase the number of smokers who receive smoking-cessation counseling from their health-care providers."
MMWR Morb Mortal Wkly Rep. 2007;56(28):708–712.