• tobacco cessation;
  • medical care survey;
  • aged;
  • clinical guidelines

OBJECTIVES: To examine recent rates of tobacco cessation counseling and whether patient age or sex was associated with providers' adherence to tobacco cessation guidelines.

DESIGN: Survey study.

SETTING: The 2002 National Ambulatory Medical Care Survey (NAMCS).

PARTICIPANTS: Analysis of 22,605 records representing 687 million ambulatory care appointments with adults from the 2002 NAMCS.

MEASUREMENTS: The proportion of visits by sex and age category during which physicians identified a patient's tobacco use status and counseled tobacco users to quit.

RESULTS: The rates at which providers inquired about tobacco use were similar across groups, ranging from 65% of visits with men aged 20 to 44 to 73% of visits with women aged 45 to 59, but providers' rates of tobacco cessation counseling differed by age, ranging from 27% of visits with male tobacco users aged 45 to 59 to 6% of visits with male tobacco users aged 75 old and older.

CONCLUSION: Although providers frequently ask their patients about tobacco use, they infrequently counsel patients to quit, especially if those patients are older men. Provider time constraints, misconceptions about older patients' ability and willingness to quit, or doubt about the potential health benefits of tobacco cessation in this age group may explain the lower counseling rates provided to older male patients. Because rates of counseling have declined in the last decade, providers should be reeducated about the need for and effectiveness of tobacco cessation counseling for men and women of all ages.