PORTLAND, Ore. - July 18, 2005 - A new study of 4,200 smokers - including 506 in Northwest Oregon and Southwest Washington - who answered a survey sent to members of nine nonprofit health plans throughout the United States showed that most smokers were asked about smoking (90 percent), more than two-thirds were advised to quit (71 percent), about half were assessed for their willingness to quit (56 percent) and given assistance for quitting (49 percent), but few had arrangements provided for follow-up (9 percent). These results of a survey mailed randomly to almost 65,000 members of the nine health plans appear in the August issue of the American Journal of Preventive Medicine.

Cigarette smoking continues to be the principal cause of premature death and preventable disease in the United States, as well as a major cause of medical expenditures and lost productivity. Of the 46.5 million American adults who smoke, nearly 70 percent see a primary care provider at least once a year. The United States Public Health Service (USPHS), in an effort to reduce cigarette smoking, recommends a five-step process called the "5A" program that includes: (1) Ask every patient about tobacco use, (2) Advise all smokers to quit, (3) Assess smokers' willingness to make a quit attempt, (4) Assist smokers with treatment and referral, and (5) Arrange follow-up contacts. The study, funded by the National Cancer Institute, provides the most comprehensive assessment yet available about the delivery of cessation services recommend by the USPHS clinical practice guidelines. Comparable information from for-profit health plans and fee-for-service physicians does not exist.

"While there is certainly room for improvement, these results are very encouraging," says Victor J. Stevens, PhD, senior investigator at Kaiser Permanente's Center for Health Research and principal investigator for the study. "I have been doing smoking cessation research for more than 20 years. Not that long ago, most smokers weren't being asked if they smoked and even fewer were getting advice and help to stop smoking. The fact that more than half of the smokers got help in getting treatment is a very good sign that progress is being made. The fact that the rest did not get treatment says that physicians and health plans still have a lot of work to do."

Stevens says he was also struck by how many smokers reported that they want their doctors to discuss cessation at most medical visits (82 percent). "There is a widespread belief that smokers do not want their doctors to talk with them about smoking and, in fact, may resent it. This study should put this myth to rest. We also found that smokers who received most of the 5A's were also significantly more satisfied with their health care and their health plans. We hope this finding will be an incentive for physicians and health plans to redouble their efforts to help smokers quit."

The study also showed that smokers who asked for help were more likely to receive assessment (81 percent) and assistance (81 percent) than smokers who did not ask (67 percent and 37 percent, respectively). Among smokers who asked for help, older age increased the likelihood of advice, and race/ethnicity (white, non-Hispanic) and better health increased reports of assistance. Among smokers who did not ask for help, older age, heavier smoking, and health plan increased the chances for getting advice, and younger age, poorer health, heavier smoking, and health plan increased the likelihood of getting assistance.

Kaiser Permanente internist Keith Bachman, MD, says the study points out that, at least in the health maintenance organizations studied, physicians do a relatively good job at asking whether their patients smoke, and advising them to quit if they do.

"This study should encourage physicians to give smoking-related advice because it shows that even if a smoker doesn't ask for help to quit, most will welcome it if their physician raises the topic to help them," says Bachman. "Where I think we can do even better is in steering those patients who indicate a willingness to quit to the appropriate resources. Working as part of a health care team, my fellow physicians and I have been getting more information to our patients about what resources our program offers, whether classes, Internet support or pharmaceutical aids, which I think is helping us help our patients more effectively."

The survey was mailed to members of nine nonprofit HMOs participating in the National Cancer Institute-funded Cancer Research Network. These plans provide medical care to more than eight million Americans. The authors of this study are affiliated with the following institutions:

• HealthPartners Research Foundation (Minneapolis, Minn.)
• Kaiser Permanente Colorado (Aurora, Colo.)
• Kaiser Permanente Northern California, Division of Research (Oakland, Calif.)
• Kaiser Permanente Northwest, Center for Health Research (Portland, Ore.)
• Kaiser Permanente Southern California, Research & Evaluation Dept. (Pasadena, Calif.)
• Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, and Harvard Pilgrim Health Care (Boston, Mass.)
• University of Massachusetts Medical School, Worcester, Meyers Primary Care Institute, Fallon Healthcare System (Worcester, Mass.)

Kaiser Permanente's Center for Health Research, founded in 1964, is a nonprofit research institution whose mission is advancing knowledge to improve health.

Kaiser Permanente is a group practice health care organization founded in 1945 and serving more than 465,000 people in Northwest Oregon and Southwest Washington.

Released: July 18, 2005