Tobacco cessation practices and beliefs among clinicians in a public hospital system

Reductions in US tobacco use have stalled, allowing smoking to remain the leading preventable cause of illness and death among adults, especially low SES and uninsured populations. Health professionals, other than physicians, can greatly impact cessation treatment. However, further research is needed to understand their current practices and beliefs. This study examines practices and beliefs regarding smoking and cessation treatment by various clinicians in a safety-net health care delivery system. Data come from a cross-sectional electronic-survey administered to 2,519 clinicians (e.g. physicians, nurses) in Louisiana’s public hospital system (83% response rate) between April and June, 2012. Descriptive data on smoking, cessation practices and beliefs, along with multivariate regression analysis of factors associated with clinical practice guideline intervention, are presented. Overall, clinicians reported low smoking rates (3.76% - 9.76%), except for nurses (RNs = 12.71%, LPNs = 14.63%). Clinicians were more likely to Ask (90.97% - 100%) about tobacco use, Advise (75.96% - 96.57) smokers to quit, and Assess (69.57% - 91.71%) their readiness to quit, but less likely to Assist (26.09% - 67.66%) smokers with their quit attempt and Arrange (2.27% - 17.82%) follow-up contact. Compared to primary care physicians who performed all 5 A’s, those who didn’t were more likely to feel uncomfortable asking patients if they smoke, and less likely to agree that as a healthcare provider tobacco use is important to address. Nurses were less likely to complete any of the 5 A’s compared to primary care physicians. And, compared to Whites, Blacks were more likely to Assist, and Latinos more likely to Arrange. Use of the evidence-based treatment model decreases as clinicians progress along the 5 A’s continuum. This information will be used to develop strategies for clinician intervention to improve adherence to the guideline.