Preventing Lung Cancer through Tobacco Cessation Quality Improvement

Treatments that can help people who smoke or use other tobacco to quit are underutilized by patients and are often not offered by health care providers. To support patient behavior change, providers must be able to offer accurate and helpful treatment for both the physical addiction to tobacco and the behaviors associated with tobacco use. It is estimated that 70% of people who smoke see their doctor in a given year, yet a recent study found that only 21% of adult patients who use tobacco received cessation counseling and less than 8% received a tobacco cessation medication(1). It is vital that we work to increase the number of health care providers offering effective treatments. 

The goal of this study is to enhance the care of tobacco users in clinical practice by developing a quality improvement program that encourages providers and practice staff to engage more purposefully in treatments that have the best chance of helping their patients who smoke or use other tobacco products quit. The program is tailored to the needs of community practices by involving practice staff and providers in its design. The objective is to identify every patient who uses tobacco, assess their readiness to quit, and offer effective counseling and medications to help them become tobacco free. In addition, practices are encouraged to follow screening and immunization protocols recommended for patients with a history of tobacco use. The team is gathering information regarding how well the program works in the practice and how much it costs to run the program. 

A second component of this project examines utilization and maintenance of tobacco research registries in U.S. cancer centers and health care systems.

Study findings will be used to help other clinics provide proven tobacco cessation services to their patients. 

Geographic area(s): Orange, Wake, and Chatham counties

Research Team: Adam Goldstein, MD, PhD, professor of family medicine (principal investigator), Jacquie Halladay, MD assistant professor of family medicine (co-investigator), Jennifer Leeman, DrPH, MDiv, assistant professor of nursing and Bryan Weiner, PhD, professor of health policy and management; staff include Carol Ripley-Moffitt, MDiv, CTTS, program director of the Nicotine Dependence Program and Morgan Ellington, research assistant.

For more information about this research study, contact Carol Ripley-Moffitt, project manager, at

(1) Jama J, Dube SR, Malarcher AM, Shwa L, Engstrom MC. Tobacco Use Screening and Counseling During Physician Office Visits Among Adults - National Ambulatory Medical Care Survey and National Health Interview Survey, United States, 2005-2009. 2012. Morbidity and Mortality Weekly Report, 61(02)38-45.