Effect on Cessation Counseling of Documenting Smoking Status as a Routine Vital Sign: An ACORN Study
Open accessAbstract
PURPOSE: Guidelines encourage primary care clinicians to document smoking status when obtaining patients' blood pressure, temperature, and pulse rate (vital signs), but whether this practice promotes cessation counseling is unclear. We examined whether the vital sign intervention influences patient-reported frequency and intensity of tobacco cessation counseling. METHODS: This study was a cluster-randomized, controlled trial conducted in the Virginia Ambulatory Care Outcomes Research Network (ACORN). At intervention practices, nurses and medical assistants were instructed to assess the tobacco use status of every adult patient and record it with the traditional vital signs. Control practices did not use any systematic tobacco screening or identification system. Outcomes were the proportion of smokers reporting clinician counseling of any kind and the frequency of 2 counseling subcomponents: simple quit advice and more intensive discussion. RESULTS: A total of 6,729 adult patients (1,149 smokers) at 18 primary care practices completed exit questionnaires during a 6-month comparison period. Among 561 smokers at intervention practices, 61.9% reported receiving any counseling, compared with 53.4% of the 588 smokers at control practices, for a difference of 8.6% (P = .04). The effect was largely restricted to simple advice, which was reported by 59.9% of intervention patients and 51.5% of control patients (P=.04). There was no significant increase in more extensive discussion, with 32.5% and 29.3% of patients at intervention and control practices, respectively, reporting this type of counseling (P=.18). CONCLUSIONS: The vital sign intervention promotes tobacco counseling at primary care practices through a modest increase in simple advice to quit. When implemented as a stand-alone intervention, it does not appear to increase intensive counseling.
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The Gordian Knot of clinical tobacco control is an inability to achieve more consistent delivery of evidence-based tobacco cessation interventions by real-world healthcare personnel.
“The Gordian Knot of clinical tobacco control is an inability to achieve more consistent delivery of evidence-based tobacco cessation interventions by real-world healthcare personnel (6, 49–52).”
From The Multiphase Optimization Strategy for Engineering Effective Tobacco Use Interventions (2011) · cites this paper as [52]
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- Authors
- Rothemich, S. F., Woolf, S. H., Johnson, R. E., Burgett, A. E., Flores, S. K., Marsland, D. W., & Ahluwalia, J. S.
- Affiliations
- Virginia Commonwealth University (US)
- University of Minnesota (US)
- Venue
- The Annals of Family Medicine
- Publisher
- Annals of Family Medicine
- Published
- 2008-01-01
- Volume
- 6
- Issue
- 1
- Pages
- 60-68
- ISSN
- 1544-1709 (ISSN-L)
- 1544-1717
- PMC
- PMC2203392
- OpenAlex
- W2144052608
- Cited by
- 53
- References
- 41
- Citations by year
- 2026: 1 · 2024: 2 · 2021: 4 · 2020: 1 · 2019: 5 · 2018: 2 · 2017: 3 · 2015: 3 · 2014: 5 · 2013: 2 · 2012: 1
- FWCI
- 5.19
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- The Annals of Family Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Robert Wood Johnson Foundation
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- smoking cessation counseling, smoking status documentation, vital signs, tobacco use screening, primary care, smoking cessation, tobacco use
- MeSH terms
- Adult, Ambulatory Care, Community-Institutional Relations, Counseling, Cross-Sectional Studies, Humans, Primary Health Care, Surveys and Questionnaires, United States, United States Dept. of Health and Human Services, Virginia, Cluster Analysis, Logistic Models, Smoking Cessation, Outcome Assessment, Health Care, Guideline Adherence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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