Attitudes and practices for smoking cessation counseling by provider type and patient age

Attitudes and self-reported practices for smoking cessation counseling among 145 providers at a health maintenance organization were compared among two provider groups, physicians/nurse practitioners and registered/licensed practical nurses, and across three patient age groups, < 50, 50-64, and > or = 65. Smoking cessation attitudes did not differ by provider type but they did differ by patient age, especially among the registered/licensed practical nurses, whose attitudes were least favorable for the oldest smokers (> or = 65). While smoking cessation practices did not differ by patient age, they did differ by provider type. Self-reported performance of the 4 As of smoking cessation practice (Ask, Advise, Assist, Arrange) was more frequent among the physicians/nurse practitioners than among the registered/licensed practical nurses. However, among both groups, asking and advising practices were reported more often than were assisting and arranging. In all cases, different attitudes were correlated with different practice behaviors for the two provider groups. Also, there were more significant correlations between age-specific attitudes and practices among the registered/licensed practical nurses than among the physicians/nurse practitioners. This was true especially regarding the oldest patients. The findings suggest a need for provider education, especially among registered/licensed practical nurses, about the benefits of smoking cessation for patients of all ages and the potential effectiveness of provider-based intervention strategies that are targeted toward specific age groups. The findings also suggest that assisting and arranging practices in particular need improvement among all types of providers.