Repeated tobacco screening linked to higher likelihood of smoking cessation treatment

Repeated screening for tobacco use with an annual clinical reminder was associated with higher probability of being prescribed smoking cessation treatment, a study of women veterans found.

The study utilized the cohort from a trial of cardiovascular risk screening and reduction in women veterans, who have a higher prevalence of smoking compared with male veterans and civilian women. A toolkit implemented at five Veterans Affairs (VA) primary care clinics included a self-administered screener to help identify personal CV risk, a clinician template in the electronic health record designed to enhance communication and shared decision making about CV risk, and a facilitated group to support goal setting, engagement, and retention in appropriate health services. Both the patient screener and clinician template included a smoking screen.

To assess the association between the number of tobacco use screenings and prescription for smoking cessation, the study included all women patients who had a VA primary care visit with a women's health clinician between Dec. 1, 2016, and March 31, 2020, at the five trial sites. The outcome was physician orders for smoking cessation treatment, which included prescriptions for nicotine replacement therapy (NRT), bupropion (150 mg), or varenicline (0.5 mg or 1 mg) and/or referrals to behavioral counseling. The researchers defined tobacco use as the use of cigarettes, cigars, pipes, snuff, dip, or chewing tobacco; the definition did not include electronic cigarettes, vaping devices, or other electronic nicotine delivery systems. Results were published June 5 by the Journal of General Internal Medicine.

During the five-year study period, out of 6,009 eligible patients, 96.3% were screened at least once for tobacco use, with 25.0% found to be current smokers and 23.1% former smokers. Among current or former smokers, 438 (15.7%) were screened once, 717 (25.8%) twice, 804 (28.9%) three times, 571 (20.5%) four times, and 254 (9.1%) five or six times. Overall, 25.5% of current or former smokers received a prescription and/or referral for smoking cessation: 13.0% received NRT, 12.2% bupropion, 3.4% varenicline, and 4.6% referral to a behavioral counseling program. The average adjusted predicted probability of prescription and/or referral for smoking cessation was 13.7% (95% CI, 7.9% to 19.5%) among current and former smokers screened once during the study period, 18.6% (95% CI, 14.3% to 22.9%) among those screened twice, 26.5% (95% CI, 26.0% to 27.0%) among those screened three times, 32.9% (95% CI, 25.3% to 40.4%) among those screened four times, and 41.7% (95% CI, 35.2% to 48.3%) among those screened five or six times.

Limitations of the study include lack of data on patients' readiness to quit, an important predictor of receiving cessation treatment, and that the study's methods may have underestimated how often patients were offered smoking cessation treatment, the study authors said.

“Smoking cessation assistance is increased with repeated asking. Repeated annual screening combined with an intervention tool focused on cardiovascular risk discussions facilitated more smoking cessation treatment referrals with prescriptions,” the authors wrote. “From these data, we recommend all primary care settings consistently ask patients at least annually about their smoking status and consider incorporating any innovations that may highlight an additional smoking discussion to enhance treatment acceptance.”