Disparities in US Healthcare Provider Screening and Advice for Cessation Across Chronic Medical Conditions and Tobacco Products
- 488 Downloads
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.
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.
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.
KEY WORDSchronic 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.
- 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
- 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
- 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
- 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.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
- 20.American Psychological Association. Diagnostic and Statistical Manual of Mental Disorders. Washington, DC; 2000.Google Scholar
- 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
- 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
- 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.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
- 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
- 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