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

Abstract

Background

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.

Objective

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

Design

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

Participants

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).

Conclusions

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.

KEY WORDS

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

Notes

Compliance with Ethical Standards

Funding

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.

References

  1. 1.
    Holford TR, Meza R, Warner KE, et al. Tobacco control and the reduction in smoking-related premature deaths in the United States, 1964–2012. JAMA. 2014;311(2):164–171.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Warner KE, Sexton DW, Gillespie BW, et al. Impact of tobacco control on adult per capita cigarette consumption in the United States. Am J Public Health. 2014;104(1):83–89.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Centers for Disease Control and Prevention. Current Cigarette Smoking Among Adults—United States, 2005–2014. Morb Mortal Wkly Rep. 2015;64(44):1233–1240.Google Scholar
  4. 4.
    Higgins ST, Kurti AN, Redner R, et al. A literature review on prevalence of gender differences and intersections with other vulnerabilities to tobacco use in the United States, 2004–2014. Prev Med. 2015;80:89–100.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Higgins ST, Kurti AN, Redner R, et al. Co-occurring risk factors for current cigarette smoking in a U.S. nationally representative sample. Prev Med. 2016.Google Scholar
  6. 6.
    Jamal A, Homa DM, O’Connor E, et al. Current cigarette smoking among adults – United States, 2005–2014. MMWR Morb Mortal Wkly Rep. 2015;64(44):1233–1240.CrossRefPubMedGoogle Scholar
  7. 7.
    Kasza KA, Ambrose BK, Conway KP, et al. Tobacco-Product Use by Adults and Youths in the United States in 2013 and 2014. N Engl J Med. 2017;376(4):342–353.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Stanton CA, Keith DR, Gaalema DE, et al. Trends in tobacco use among US adults with chronic health conditions: National Survey on Drug Use and Health 2005–2013. Prev Med. 2016.Google Scholar
  9. 9.
    Danesh D, Paskett ED, Ferketich AK. Disparities in receipt of advice to quit smoking from health care providers: 2010 National Health Interview Survey. Prev Chronic Dis. 2014;11:E131.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Fiore MC, Jaen CR. A clinical blueprint to accelerate the elimination of tobacco use. JAMA. 2008;299(17):2083–2085.CrossRefPubMedGoogle Scholar
  11. 11.
    Nicholson JM, Hennrikus DJ, Lando HA, et al. Patient recall versus physician documentation in report of smoking cessation counselling performed in the inpatient setting. Tob Control. 2000;9(4):382–388.CrossRefPubMedCentralGoogle Scholar
  12. 12.
    Thorndike AN, Rigotti NA, Stafford RS, et al. National patterns in the treatment of smokers by physicians. JAMA. 1998;279(8):604–608.CrossRefPubMedGoogle Scholar
  13. 13.
    Lucan SC, Katz DL. Factors associated with smoking cessation counseling at clinical encounters: the Behavioral Risk Factor Surveillance System (BRFSS) 2000. Am J Health Promot. 2006;21(1):16–23.CrossRefPubMedGoogle Scholar
  14. 14.
    Ossip-Klein DJ, McIntosh S, Utman C, et al. Smokers ages 50+: who gets physician advice to quit? Prev Med. 2000;31(4):364–369.CrossRefPubMedGoogle Scholar
  15. 15.
    Spangler JG, Song EY, Pockey JR, et al. Predictors of Clinician Tobacco Intervention Counseling in Six North Carolina Free Clinics. Tob Use Insights. 2012;20125:11–16.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Tomar SL, Husten CG, Manley MW. Do dentists and physicians advise tobacco users to quit? J Am Dent Assoc. 1996;127(2):259–265.CrossRefPubMedGoogle Scholar
  17. 17.
    Substance Abuse and Mental Health Services Administration (SAMSHA). Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings. NSDUH Series H-46 (HHS Publication No (SMA) 14–4863). Rockville, MD; 2014.Google Scholar
  18. 18.
    Substance Abuse and Mental Health Services Administration (SAMSHA). 2014 National Survey on Drug Use and Health: Methodological Summary and Definitions. Cent Behav Health Stat Qual. 2015.Google Scholar
  19. 19.
    Goodman RA, Posner SF, Huang ES, et al. Defining and measuring chronic conditions: imperatives for research, policy, program, and practice. Prev Chronic Dis. 2013;10:E66.PubMedPubMedCentralGoogle Scholar
  20. 20.
    American Psychological Association. Diagnostic and Statistical Manual of Mental Disorders. Washington, DC; 2000.Google Scholar
  21. 21.
    Kruger J, Shaw L, Kahende J, et al. Health care providers’ advice to quit smoking, National Health Interview Survey, 2000, 2005, and 2010. Prev Chronic Dis. 2012;9:E130.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Weaver KE, Danhauer SC, Tooze JA, et al. Smoking cessation counseling beliefs and behaviors of outpatient oncology providers. Oncologist. 2012;17(3):455–462.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Schauer GL, Wheaton AG, Malarcher AM, et al. Health-care Provider Screening and Advice for Smoking Cessation Among Smokers With and Without COPD: 2009–2010 National Adult Tobacco Survey. Chest. 2016;149(3):676–684.CrossRefPubMedGoogle Scholar
  24. 24.
    Fiore MC, Jaen CR, Baker TB, et al. A Clinical Practice Guideline for Treating Tobacco Use and Dependence: 2008 Update – A US Public Health Service report. Am J Prev Med. 2008;35(2):158–176.CrossRefGoogle Scholar
  25. 25.
    US Department of Health and Human Services. The health consequences of smoking—50 years of progress. A report of the Surgeon General. US Dept of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 2014.Google Scholar
  26. 26.
    McMillen RC, Gottlieb MA, Shaefer RM, et al. Trends in Electronic Cigarette Use Among U.S. Adults: Use is Increasing in Both Smokers and Nonsmokers. Nicotine Tob Res. 2015;17(10):1195–1202.CrossRefGoogle Scholar
  27. 27.
    US Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Atlanta, GA; 2016.Google Scholar
  28. 28.
    Virtanen SE, Zeebari Z, Rohyo I, et al. Evaluation of a brief counseling for tobacco cessation in dental clinics among Swedish smokers and snus users. A cluster randomized controlled trial (the FRITT study). Prev Med. 2015;70:26–32.CrossRefPubMedGoogle Scholar
  29. 29.
    Callaghan RC, Veldhuizen S, Jeysingh T, et al. Patterns of tobacco-related mortality among individuals diagnosed with schizophrenia, bipolar disorder, or depression. J Psychiatr Res. 2014;48(1):102–110.CrossRefGoogle Scholar
  30. 30.
    Druss BG, Zhao L, Von Esenwein S, et al. Understanding excess mortality in persons with mental illness: 17-year follow up of a nationally representative US survey. Med Care. 2011;49(6):599–604.CrossRefPubMedGoogle Scholar
  31. 31.
    Centers for Disease Control and Prevention. Vital Signs: Current Cigarette Smoking Among Adults Aged ≥18 Years With Mental Illness—United States, 2009–2011. Morb Mortal Wkly Rep. 2013;62(05):81–87.Google Scholar
  32. 32.
    Centers for Disease Control and Prevention. Vital Signs Fact Sheet: Adult Smoking Focusing on People with Mental Illness, February 2013. National Center for Chronic Disease and Health Promotion, Office on Smoking and Health. 2013.Google Scholar
  33. 33.
    Banham L, Gilbody S. Smoking cessation in severe mental illness: what works? Addiction. 2010;105(7):1176–1189.CrossRefPubMedGoogle Scholar
  34. 34.
    Centers for Disease Control and Prevention. Quitting smoking among adults—United States, 2001–2010. MMWR Morb Mortal Wkly Rep. 2011;60(44):1513–1519.Google Scholar
  35. 35.
    Kotz D, Brown J, West R. ‘Real-world’ effectiveness of smoking cessation treatments: a population study. Addiction. 2014;109(3):491–499.CrossRefGoogle Scholar
  36. 36.
    Silagy CL, Stead L, Mant D, Fowler G. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2004;3(Art. No.: CD000146).Google Scholar

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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