conducted by the National Center for Health Statistics in 2001–2003 found that physicians identified smoking status during 68% of office visits and counseled about 20% of smokers during their visits. Pregnant women were most frequently asked about their smoking status but were the least likely to receive smoking counseling. The use of tobacco-cessation medication, primarily prescription bupropion, was recorded in only 1.7% of visits (Thorndike et al., 2007). A Cochrane review found that training of health-care providers increased the likelihood that they would offer evidence-based cessation interventions during patient visits (Lancaster et al., 2000).

Numerous training programs are available for health-care providers, some of them free of charge. For example, the University of California, San Francisco, has a program, Rx for Change: Clinician-Assisted Tobacco Cessation, that trains health-professionals, students, and licensed clinicians in the 5 A’s or the Ask-Advise-Refer model (accessible at http://www.rxforchange.ucsf.edu). The 2AandR online program, sponsored by the Washington State Department of Health and run by Free and Clear, Inc., also offers training and resources to healthcare providers based on the 2008 PHS guideline. The American Lung Association’s Tobacco Cessation Resource Center has electronic resources for health-care providers to use in their clinics and organizations; providers are able to request additional assistance as needed (accessible at http://www.tobaccoprc.org/page.cfm?id=9).

There is a lack of training among mental-health professionals, primary-care providers, and tobacco-cessation specialists with regard to tobacco-cessation interventions for patients with psychiatric disorders (Williams and Ziedonis, 2006). Training psychiatrists to provide cognitive-behavior therapy to mental-health patients for tobacco cessation within the psychodynamic therapeutic model taught in most psychiatric residencies may be challenging inasmuch as only about half the psychiatry residencies require cognitive-behavior therapy training (Prochaska et al., 2007).

Provider-level strategies for increasing patient use of cessation interventions include electronic or written prompts and reminders on medical charts or records such as the assessment and documentation of tobacco-use status as a vital sign at every health-care visit (Fiore et al., 2008). For example, primary-care physicians who used a computer report of their patients’ smoking status that included tailored recommendations for discussing smoking cessation were more likely to have abstinent patients at a 6-month follow-up than those who supplied standard care (Smith et al., 2007; Unrod et al., 2007). Provider reminder systems have been shown to be effective in increasing tobacco cessation, particularly when combined with provider education (CDC, 2009a).



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