Tobacco use is still fairly common; in the United States. In 2020, 20.7% of the U.S. population over age 12 used tobacco or engaged in nicotine vaping in the past month, according to 2020 National Survey on Drug Use and Health data (SAMHSA, 2022). The form used most often was still cigarettes (15% of the population), followed by cigars (3.8%), and nicotine vaping (3.8%).
Tobacco use in the form of smoking and secondhand smoke is estimated to be responsible for more than 480,000 premature deaths annually (CDC, 2019) and causes significant morbidity (USDHHS, 2020). The effectiveness of tobacco interventions by health care providers was evaluated in a review of the literature by the review panel for the U.S. Public Health Service Clinical Practice Guideline, Treating Tobacco Use and Dependence: 2008 Update (Fiore, et al., 2008). They found that medication and counseling are more effective for promoting tobacco cessation than no treatment and that intervention effectiveness increases with increased intervention intensity. The Clinical Practice Guideline (Fiore, et al., 2008), also provided evidence-based guidelines for clinicians on how to provide brief and more extensive interventions in tobacco use. These basic guidelines continue to prove to be effective with minor changes, particularly to include a few newer pharmacological treatments and note some associated precautions (USPSTF, 2021; Berkowitz et al., 2022).
Despite the documented need for tobacco cessation and the effectiveness of clinical interventions and the availability of practice guidelines, many health providers are not providing evidence-based tobacco interventions. A focus group of 30 NYC physicians found that only 60% had formal training in treating tobacco dependence/use (Kilgore et al, 2021). Many physicians studied had a low level of confidence in the efficacy of approved medications. While they mostly understood the risks of smoking and the basics of counseling and prescribing medications, not all physicians were treating smoking and those who were, often were not following guidelines. Barriers reported included insufficient time and reimbursement. Many of the primary care participants reported not feeling adequately trained to provide behavior change counseling that is needed. Another study that observed 38 physicians during counseling confirmed that counseling skills needed improving, in particular, the use of empathy and evoking the patient’s ideas and feelings (Champassak et al., 2014).
Training health care professionals in evidence-based, brief tobacco interventions in order to assure that all health providers know and are confident to provide tobacco interventions will help address this practice gap.
Practice Gap References
- Berkowitz D, Park J, Rupp K, et al. Tobacco Control Network: 2022 Policy Recommendations Guide. 2022:50.
- CDC. Smoking and Tobacco Use. Fast Facts. Updated November 2019. Available at: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm
- Champassak SL, Catley D, Finocchario-Kessler S, et al. Physician smoking cessation counseling and adherence to a clinical practice guideline. Eur J Pers Cent Healthc. 2014;2(4):477-484. doi:10.5750/ejpch.v2i4.833. PMCID: PMC4533879. PMID: 26279853.
- Department of Health and Human Services (USDHHS). The Health Consequences of Smoking: A Report of the Surgeon General. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; Washington, D.C.: For sale by the Supt. of Docs., U.S. G.P.O.. 2004. Available at: https://www.cdc.gov/tobacco/data_statistics/sgr/2004/complete_report/index.htm/index.htm Accessed on: 2014-04-28.
- Fiore MC, Bailey WC, Cohen SJ, et al. Clinical Practice Guideline: Treating Tobacco Use and Dependence. Rockville, Md: Public Health Service, US Dept of Health and Human Services. 2000.
- Kilgore EA, Waddell EN, Tannert Niang KM, Murphy J, Thihalolipavan S, Chamany S. Provider Attitudes and Practices on Treating Tobacco Dependence in New York City After 10 years of Comprehensive Tobacco Control Efforts. J Prim Care Community Health. February 23, 2021;12:2150132720957448. doi:10.1177/2150132720957448. PMCID: PMC7907932. PMID: 33622072.
- National Center for Chronic Disease Prevention and Health Promotion. Targeting tobacco use: the nation’s leading cause of death, at-a-glance. CDC Web site. 2010. Available at: https://stacks.cdc.gov/view/cdc/5527 Accessed on: 2016-09-06.
- Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2020 National Survey on Drug Use and Health. Rockville, MD: Center for Behavioral Health Statistics and Quality; 2022.
- USDHHS. Smoking Cessation. A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2020. https://www.hhs.gov/sites/default/files/2020-cessation-sgr-full-report.pdf. Accessed February 5, 2020.
- US Preventive Services Task Force. Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons: US Preventive Services Task Force Recommendation Statement. JAMA. January 19, 2021;325(3):265-279. doi:10.1001/jama.2020.25019.
