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

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

doi:10.1007/s11606-017-4062-6

Cited by 32 publications

(37 citation statements)

References 30 publications

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“…Our findings are also consistent with earlier reports that 60 percent of patients in CHCs in New York City were missing smoking documentation between 2009 and 2012, and that 85 percent of patients in a nationally representative sample reported that providers asked them about tobacco use in 2013‐2014 . Like our study, both of these studies found that smoking documentation was significantly more common for patients with comorbidities than for those without.…”

Section: Discussionsupporting

confidence: 92%

“…32 This study is the first to examine rates of smoking documenta- about tobacco use in 2013-2014. 35 Like our study, both of these studies found that smoking documentation was significantly more common for patients with comorbidities than for those without. Additionally, both our study and the New York study found that smoking status documentation was more common for older patients.…”

Section: Discussionsupporting

confidence: 71%

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Trends in smoking documentation rates in safety net clinics

Fortmann

Bailey

Brooks

et al. 2020

Health Services Research

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Objective To assess the impact of provider incentive policy on smoking status documentation. Data Sources Primary data were extracted from structured electronic medical records (EMRs) from 15 community health centers (CHCs). Study Design This was an observational study of data from 2006 to 2013, assessing changes in documentation of smoking status over time. Data Extraction Methods We extracted structured EMR data for patients age 18 and older with at least one primary care visit. Principal Findings Rates of documented smoking status rose from 30 percent in 2006 to 90 percent in 2013; the largest increase occurred from 2011 to 2012 following policy changes (21.3% [95% CI, 8.2%, 34.4%] from the overall trend). Rates varied by clinic and across patient subgroups. Conclusions Documentation of smoking status improved markedly after introduction of new federal standards. Further improvement in documentation is still needed, especially for males, nonwhite patients, those using opioids, and HIV + patients. More research is needed to study whether changes in documentation lead to improvements in counseling, cessation, and patient outcomes.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 71%

Trends in smoking documentation rates in safety net clinics

Fortmann

Bailey

Brooks

et al. 2020

Health Services Research

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“…Several recent studies have examined cigarette smoking and other tobacco use among those with and without chronic health conditions. Individuals with chronic conditions have higher prevalence of smoking and non-cigarette tobacco use, and have not exhibited the same declines in smoking prevalence over time as those without chronic conditions ( Keith et al, 2017 ; Stanton et al, 2016 ). However, there is promising evidence to suggest that individuals with chronic health conditions attempt to quit smoking at higher rates than those without these conditions and may also have greater motivation to quit ( Duffy et al, 2011 ; Gaalema et al, 2018 ; Kalkhoran et al, 2018 ).…”

Section: Introductionmentioning

confidence: 97%

Response to reduced nicotine content cigarettes among smokers with chronic health conditions

Streck

Bergeria

Parker

et al. 2018

Preventive Medicine Reports

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Individuals with chronic health conditions persist in smoking despite the presence of smoking-related illness. The aim of this study was to examine whether chronic health conditions moderate response to reduced nicotine content cigarettes (0.4, 2.4, 5.2, 15.8 mg/g of tobacco). This is a secondary analysis of a controlled clinical laboratory study that examined the acute effects of cigarettes varying in nicotine content among individuals especially vulnerable to smoking and tobacco dependence. Participants in the present study were categorized as having 0, 1–2, or ≥3 smoking-related chronic health conditions (i.e., chronic condition severity, CCS). Repeated-measures analysis of variance was used to examine whether CCS moderated response to cigarettes across measures of addiction potential (i.e., concurrent choice testing between nicotine dose pairs, Cigarette Purchase Task (CPT) performance, positive subjective effects), tobacco withdrawal, cigarette craving, and smoking topography. No main effects of CCS or interactions of CCS and nicotine dose were observed for concurrent choice testing, positive subjective effects, tobacco withdrawal, or smoking topography. Main effects of CCS were noted on the CPT with greater CCS being associated with less persistent demand. There was an interaction of CCS and nicotine dose on Factor 1 of the Questionnaire on Smoking Urges with the effects of dose significant only among those with 1–2 chronic conditions. Overall, we see minimal evidence that chronic condition severity affects response to reduced nicotine content cigarettes. A policy that reduces the nicotine content of cigarettes to minimally addictive levels may benefit smokers already experiencing smoking-related chronic conditions.

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“…Such advice is especially needed by African-American smokers because they have lower smoking quit rates than Whites, and suffer disproportionately from tobacco-related diseases ( Trinidad et al, 2011 ; Haiman et al, 2006 ). Studies have found however that African-American smokers are significantly less likely than White smokers to receive cessation advice from HCPs ( Danesh et al, 2014 ; Kruger et al, 2012 ; Lopez-Qunitero et al, 2006 ; Reed and Bums, 2008 ; Houston et al, 2005 ; Cokkinides et al, 2008 ; Keith et al, 2017 ). Demographic (i.e., age, gender), healthcare (i.e., health insurance, a regular doctor), amount of smoking, and health status (i.e., hypertension, diabetes, obesity) contribute to receiving cessation advice from HCPs, but racial disparities in receipt of that advice remain after controlling for those variables ( Danesh et al, 2014 ; Kruger et al, 2012 ; Lopez-Qunitero et al, 2006 ; Reed and Bums, 2008 ; Houston et al, 2005 ; Cokkinides et al, 2008 ; Keith et al, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Racial disparities in healthcare provider advice to quit smoking

Landrine

Corral

Campbell

2018

Preventive Medicine Reports

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African-American/Black smokers are less likely than White smokers to be told to quit smoking by healthcare providers. This preliminary study examined the predictors of being told to quit separately by race for the first time to potentially highlight the source of this racial disparity. A random, household sample of 1670 Black and White adults from a southeastern county of the United States completed a brief survey on their demographics, smoking, access to healthcare, health status, and receipt of healthcare provider advice to quit smoking. Analyses are based on the 512 Black and White smokers in that sample. The logistic regression for all smokers revealed that after controlling for demographic, healthcare, and health status variables, White smokers were 2.39 times more likely than Black smokers to have ever been told to quit smoking. The regression for Black smokers revealed that women and older people were more likely to be told to quit, and that healthcare and health status did not contribute. In the regression for White smokers, no predictor was statistically significant. These findings suggest that one possible reason that African-Americans receive cessation advice less often than Whites is that such advice varies with their age and gender, whereas for Whites this is not the case.

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

Cited by 32 publications

References 30 publications

Trends in smoking documentation rates in safety net clinics

Trends in smoking documentation rates in safety net clinics

Response to reduced nicotine content cigarettes among smokers with chronic health conditions

Racial disparities in healthcare provider advice to quit smoking

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