Focusing on the Five A's

INTRODUCTION: The prevalence of smoking remains high among the medically underserved and could be related to disparities in access to and use of smoking cessation treatments. METHODS: This study implemented and tracked providers' use of the 5 A's intervention for tobacco use (Ask, Assess, Advise, Assist, Arrange) with homeless (n = 260) and housed (n = 226) adults attending a free medical clinic, including referrals to and use of an on-site pharmacist-led smoking cessation service. RESULTS: Among patients whose tobacco use was Asked about and Assessed (97%), homeless (vs. housed) patients were more likely to smoke (59% vs. 39%; P = 0.008). Among current smokers, there were no homeless-housed disparities in receipt of Advice to quit smoking (84% vs. 78%; P = 0.22) or Arrangement of treatment (36% vs. 31%; P = 0.46). Overall, among patients for whom treatment was Arranged, homeless patients were less likely than housed patients to attend the smoking cessation program (25% vs. 48%; P = 0.04). However, among those that attended any treatment (i.e., were Assisted to quit), homeless and housed patients attended similar numbers of sessions and used pharmacotherapy at similar rates. CONCLUSIONS: Providers may reduce homeless-housed disparities in smoking by offering special Assist(ance) to homeless smokers that reduces barriers to initially accessing treatment services.