Journal of Community Health

, Volume 36, Issue 2, pp 238–243 | Cite as

Training Physicians to Do Office-based Smoking Cessation Increases Adherence to PHS Guidelines

  • Lee CaplanEmail author
  • Charlotte Stout
  • Daniel S. Blumenthal
Original Paper


Cigarette Smoking is the leading cause of preventable mortality and morbidity in the United States. Healthcare providers can contribute significantly to the war against tobacco use; patients advised to quit smoking by their physicians are 1.6 times more likely to quit than patients not receiving physician advice. However, most smokers do not receive this advice when visiting their physicians. The Morehouse School of Medicine Tobacco Control Research Program was undertaken to develop best practices for implementing the “2000 Public Health Services Clinical Practice Guidelines on Treating Tobacco Use and Dependence” and the “Pathways to Freedom” tobacco cessation program among African American physicians in private practice and healthcare providers at community health centers. Ten focus groups were conducted; 82 healthcare professionals participated. Six major themes were identified as barriers to the provision of smoking cessation services. An intervention was developed based on these results and tested among Georgia community-based physicians. A total of 308 charts were abstracted both pre- and post-intervention. Charts were scored using a system awarding one point for each of the five “A’s” recommended by the PHS guidelines (Ask, Advise, Assess, Assist, Arrange) employed during the patient visit. The mean pre-intervention five “A’s” score was 1.29 compared to 1.90 post-intervention (P < 0.001). All charts had evidence of the first “A” (“asked”) both pre- and post-intervention, and the other four “A’s” all had statistically significant increases pre-to post-intervention. Conclusions: The results demonstrate that, with training of physicians, compliance with the PHS tobacco guidelines can be greatly improved.


Five “A’s” Smoker Smoking cessation Training physicians Tobacco 



The authors gratefully acknowledge the work of Dr. Mary Frazier on this project. Funding: Supported by grant U57CCU42068 (Community Cancer Control) from the Centers for Disease Control and Prevention (CDC) with additional support from grant 5U48DP000049 (Prevention Research Center) from the CDC, grant 1U01CA1146520 (Community Networks Program) from the National Cancer Institute (NCI), grant 2U54CA118638 (Minority Institution/Cancer Center Partnership) from the NCI, grant 1UL1RR025008 (Clinical Research Center) from the National Center for Research Resources, and grant UL1RR025008 (CTSA) from NCRR.


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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Lee Caplan
    • 1
    Email author
  • Charlotte Stout
    • 2
  • Daniel S. Blumenthal
    • 3
  1. 1.Department of Community Health and Preventive MedicineMorehouse School of MedicineAtlantaGAUSA
  2. 2.Oklahoma State Department of HealthOklahoma CityUSA
  3. 3.Morehouse School of MedicineAtlantaUSA

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