Problem/Objective: The uninsured are more likely to smoke and less likely to receive smoking cessation advice from health professionals compared to the insured. One reason may be lack of access to cessation services among the uninsured.

Methods: We surveyed all free clinics in North Carolina to determine the availability and type of smoking cessation services offered to patients. Only 14 of 55 free clinics (25%) indicated that they offered any type of cessation service on site. A follow-up study revealed that clinics vary considerably in what they offer.

Results: Most offer self-help materials, encourage physicians to advise patients to quit, and include smoking status on patient intake forms. However, only half were aware of “quit lines,” offer signs or other media encouraging patients to quit, provide nicotine replacement therapy, or have a dedicated staff person to help patients quit. Only 2 clinics indicated that they evaluate whether healthcare professionals offer tobacco cessation advice to their patients. Only 1 clinic had used the Centers for Disease Control and Prevention, National Cancer Institute or the American Lung Association to obtain additional information about smoking cessation and no clinics had used information from the National Heart, Lung, and Blood Institute, the Cancer Information Service or the Legacy Foundation.

Conclusions: Patients of free clinics are not receiving cessation services that have been proven effective in other healthcare settings. Although free clinics are an excellent avenue to reach the uninsured, they have yet to undertake organizational changes that would promote tobacco cessation among their patients.