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Health Services Research & Development

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2006 HSR&D National Meeting Abstract

3072 — Tobacco Counseling Across the Ages

Author List:
Wallace AE (VA Outcomes Group, Dartmouth Medical School)
Weeks WB (VA Outcomes Group, NCPS, VAQS, Dartmouth Medical School)

Clinical guidelines support provision of tobacco cessation counseling to users at every clinical encounter as tobacco cessation affords benefits to users at any age. We assessed current rates of tobacco cessation counseling and determined whether patient age or gender influenced providers’ compliance with tobacco cessation guidelines.

From the 2002 National Ambulatory Medical Care Survey, we obtained 15,678 records representing 470 million ambulatory appointments with patients age 20 and older. We assessed rates of tobacco use inquiry and identified 2,664 records representing 78 million self-identified tobacco users. We then compared providers’ rates of tobacco cessation counseling for male and female tobacco users in four age groups.

Rates of tobacco use ranged from 22% among 40-59 year olds to 4% among those 80 and older; tobacco use among males exceeded that for females in every age category. Rates of tobacco inquiry were similar across groups, ranging from inquiry in 95% of visits with 20-39 year olds to inquiry in 91% of visits with patients 80 and older (p=0.14). Providers’ rates of tobacco cessation counseling for tobacco users differed by age, ranging from counseling in 7% of visits with users ages 20-39 and 40-59 to counseling in 1% of visits with users age 80 and older. Counseling rates also varied by gender: when compared to the referent group (females age 20-39), providers were only half as likely to counsel tobacco using females age 60-79 (p=0.004), less than 20% as likely to counsel female tobacco users age 80 or older (p=0.02), and about 10% as likely to counsel male tobacco users age 80 or older (p=0.006).

Though providers frequently ask their patients about tobacco use, they rarely counsel patients to quit. Especially troubling is their neglect of older patients, beginning with female patients as young as age 60. Provider time constraints, misconceptions about older patients’ ability and willingness to quit, or doubt about the potential health benefits of tobacco cessation in this age group may explain the lower counseling rates provided to older patients.

Providers should be reeducated about the need for tobacco cessation counseling for men and women of all ages.

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