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Effectiveness of the 5-As Tobacco Cessation Treatments in Nine HMOs

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ABSTRACT

BACKGROUND

Smoking remains the leading cause of preventable mortality in the US. The national clinical guideline recommends an intervention for tobacco use known as the 5-As (Ask, Advise, Assess, Assist, and Arrange). Little is known about the model’s effectiveness outside the research setting.

OBJECTIVE

To assess the effectiveness of tobacco treatments in HMOs.

PARTICIPANTS

Smokers identified from primary care visits in nine nonprofit health plans.

DESIGN/METHODS

Smokers were surveyed at baseline and at 12-month follow-up to assess smoking status and tobacco treatments offered by clinicians and used by smokers.

RESULTS

Analyses include the 80% of respondents who reported having had a visit in the previous year with their clinician when they were smoking (n = 2,325). Smokers were more often offered Advice (77%) than the more effective Assist treatments–classes/counseling (41%) and pharmacotherapy (33%). One third of smokers reported using pharmacotherapy, but only 16% used classes or counseling. At follow-up, 8.9% were abstinent for >30 days. Smokers who reported being offered pharmacotherapy were more likely to quit than those who did not (adjusted OR = 1.73, CI = 1.22–2.45). Compared with smokers who didn’t use classes/counseling or pharmacotherapy, those who did use these services were more likely to quit (adjusted OR = 1.82, CI = 1.16–2.86 and OR = 2.23, CI = 1.56–3.20, respectively).

CONCLUSIONS

Smokers were more likely to report quitting if they were offered cessation medications or if they used either medications or counseling. Results are similar to findings from clinical trials and highlight the need for clinicians and health plans to provide more than just advice to quit.

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Acknowledgements

This study was conducted within the Cancer Research Network (CRN), a consortium of non-profit HMOs funded by the National Cancer Institute to increase the effectiveness of preventive, curative, and supportive cancer-related interventions. We are grateful for the work and dedication of the investigators and research staff from the health plans participating in the HMOs Investigating Tobacco (HIT) study: Group Health Cooperative of Puget Sound, Seattle, WA; Harvard Pilgrim Health Care, Boston, MA; Health Alliance Plan of Michigan, Detroit, MI; HealthPartners, Minneapolis, MN; Kaiser Permanente Colorado, Denver, CO; Kaiser Permanente Hawaii, Honolulu, HI; Kaiser Permanente Northern California, Oakland, CA; Kaiser Permanente Northwest, Portland, OR; Kaiser Permanente Southern California, Pasadena, CA. Special thanks are given to the staff at the Survey Center at Health Partners. This study was funded by grant U19 CA79689 from the National Cancer Institute.

Conflict of Interest

In the past 3 years Dr. Quinn served as a co-investigator on studies funded by Pfizer and Sanofi-Aventis and Dr. Rigotti served as a consultant to Pfizer and Sanofi-Aventis and received research grants from Pfizer, Sanofi-Aventis, and Nabi Biopharmaceuticals.

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Authors and Affiliations

  1. Research & Evaluation Department, Kaiser Permanente Southern California, 100 So. Los Robles Ave, 2nd Fl., Pasadena, CA, 91188, USA

    Virginia P. Quinn PhD

  2. Kaiser Permanente Northwest, Center for Health Research, Portland, OR, USA

    Jack F. Hollis PhD, K. Sabina Smith BS, Weiming Hu MS & Victor J. Stevens PhD

  3. Tobacco Research and Treatment Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Nancy A. Rigotti MD

  4. HealthPartners Research Foundation, Minneapolis, MN, USA

    Leif I. Solberg MD

Authors
  1. Virginia P. Quinn PhD
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  2. Jack F. Hollis PhD
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  3. K. Sabina Smith BS
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  4. Nancy A. Rigotti MD
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  5. Leif I. Solberg MD
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  6. Weiming Hu MS
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  7. Victor J. Stevens PhD
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Correspondence to Virginia P. Quinn PhD.

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Quinn, V.P., Hollis, J.F., Smith, K.S. et al. Effectiveness of the 5-As Tobacco Cessation Treatments in Nine HMOs. J GEN INTERN MED 24, 149–154 (2009). https://doi.org/10.1007/s11606-008-0865-9

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  • DOI: https://doi.org/10.1007/s11606-008-0865-9

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