Journal of General Internal Medicine

, Volume 32, Issue 9, pp 974–980 | Cite as

Disparities in US Healthcare Provider Screening and Advice for Cessation Across Chronic Medical Conditions and Tobacco Products

  • Diana R. Keith
  • Cassandra A. Stanton
  • Diann E. Gaalema
  • Janice Y. Bunn
  • Nathan J. Doogan
  • Ryan Redner
  • Allison N. Kurti
  • Antonio Cepeda-Benito
  • Alexa A. Lopez
  • Adam L. Morehead
  • Megan E. Roberts
  • Stephen T. Higgins
Original Research



Disparities in tobacco use are worsening in the United States, disproportionately affecting those with chronic medical conditions. One possible contributor is that physicians may not screen and advise cessation uniformly across patients and/or tobacco products.


This study examined provider communications regarding cigarette and non-cigarette tobacco products among adults with chronic conditions.


Cross-sectional study drawn from two waves (2013–2014) of the National Survey on Drug Use and Health (NSDUH).


Adults (≥ 18 years) who used tobacco in the past year.

Main Measures

Prevalence of tobacco use included past-year use of cigarettes, cigars, or smokeless tobacco among those with and without chronic conditions. Chronic conditions included asthma, anxiety, coronary heart disease, depression, diabetes, hepatitis, HIV, hypertension, lung cancer, stroke, and substance abuse. Odds ratio of receipt of screening and advice to quit across chronic condition and tobacco product type were reported. Data were analyzed using logistic regression, controlling for basic sociodemographic factors and number of provider visits.

Key Results

Adults with anxiety, depression, and substance use disorders had the highest prevalence of past-year cigarette (37.2–58.2%), cigar (9.1–28.0%), and smokeless tobacco (3.1–11.7%) use. Patients with any chronic condition were more likely to receive advice to quit than those without a condition (OR 1.21–2.37, p < 0.01), although the odds were lowest among adults with mental health and substance use disorders (OR 1.21–1.35, p < 0.01). Cigarette smokers were more likely to report being screened and advised to quit than non-cigarette tobacco users (OR 1.54–5.71, p < 0.01).


Results support the need for provider training to expand screening and cessation interventions to include the growing spectrum of tobacco products. Screening and referral to interventions are especially needed for those with mental health and substance use disorders to reduce the disparate burden of tobacco-related disease and death.


chronic conditions tobacco use comorbidity physician advice cigarettes cigars smokeless tobacco health disparities 


Compliance with Ethical Standards


This project was supported in part by Centers of Biomedical Research Excellence award P20GM103644 from the National Institute of General Medical Sciences, and Institutional Training Award T32DA07242 from the National Institute on Drug Abuse. The funding sources had no role in this project other than financial support.

Conflict of Interest

The authors declare that they do not have a conflict of interest.


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Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  • Diana R. Keith
    • 1
  • Cassandra A. Stanton
    • 2
    • 3
  • Diann E. Gaalema
    • 1
  • Janice Y. Bunn
    • 1
    • 4
  • Nathan J. Doogan
    • 5
  • Ryan Redner
    • 1
    • 6
  • Allison N. Kurti
    • 1
  • Antonio Cepeda-Benito
    • 7
  • Alexa A. Lopez
    • 1
  • Adam L. Morehead
    • 1
  • Megan E. Roberts
    • 5
  • Stephen T. Higgins
    • 1
  1. 1.Vermont Center on Behavior and Health, Department of PsychiatryUniversity of VermontBurlingtonUSA
  2. 2.WestatRockvilleUSA
  3. 3.Department of OncologyGeorgetown University Medical Center/Cancer Prevention and Control ProgramWashingtonUSA
  4. 4.Department of Medical BiostatisticsUniversity of VermontBurlingtonUSA
  5. 5.College of Public HealthThe Ohio State UniversityColumbusUSA
  6. 6.Rehabilitation InstituteSouthern Illinois UniversityCarbondaleUSA
  7. 7.Department of Psychological ScienceUniversity of VermontBurlingtonUSA

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