Factors associated with smoking cessation attempts in a public, safety-net primary care system

Suen, Leslie W.; Rafferty, Henry; Le, Thao; Chung, Kara; Straus, Elana; Chen, Ellen; Vijayaraghavan, Maya

doi:10.1016/j.pmedr.2022.101699

Cited by 3 publications

(11 citation statements)

References 40 publications

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“…However, since the pandemic, health systems, including the San Francisco Health Network, have transitioned to providing tobacco treatment using telehealth models of care. 21 In this study, we extend our prior work 19 , 20 by describing previously unexplored patient factors associated with receipt of cessation services, quit attempts, and sustained cessation during the pandemic. Social determinants of health like housing are linked with tobacco use, 22 and we were able to obtain information on housing status for the present analysis.…”

Section: Introductionmentioning

confidence: 70%

“…We assessed independent variables at the patients’ index visit including patient demographics (age [18–44, 45–64, 65 +], 19 , 20 sex [male vs. female], race/ethnicity [non-Hispanic White [NHW], Hispanic, non-Hispanic Black [NHB], non-Hispanic Asian [NHA], and non-Hispanic other [NHO]], and primary language), social determinants of health (health insurance and housing status [experiencing homelessness or housed]), and comorbidity burden (number of smoking-related comorbidities [0, 1, 2, ≥ 3] including heart failure, chronic obstructive pulmonary disease, kidney disease, coronary artery disease, depression, diabetes, HIV, hyperlipidemia, and hypertension). We identified comorbidities using ICD-10 codes.…”

Section: Methodsmentioning

confidence: 99%

“…However, only a few studies used the EHR to assess patient characteristics associated with cessation behaviors and receipt of cessation services in safety-net settings. 9 , 17 , 19 , 20 The results varied depending on the clinical setting and patient population. A study using 2014–2016 EHR data from safety-net clinics in the Oregon Community Health Information Network showed that Medicare patients were less likely to receive counseling and racial and ethnic minorities were less likely to have cessation medications prescribed.…”

Section: Introductionmentioning

confidence: 99%

“… 19 In the same setting, patients who were older, were insured by Medicaid or uninsured, and had limited English proficiency had a lower likelihood of quit attempts. 20 …”

Section: Introductionmentioning

confidence: 99%

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Factors Associated with Smoking Cessation and the Receipt of Cessation Services in a Public, Safety-Net Primary Care System

Gu,

Rafferty,

Vijayaraghavan

2024

J GEN INTERN MED

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Background Prevalence of smoking is high among patients receiving care in safety-net settings, and there is a need to better understand patient factors associated with smoking cessation and receipt of cessation services. Objective To identify patient factors associated with smoking cessation attempts and receipt of cessation counseling and pharmacotherapy in a large safety-net health system. Design We conducted a retrospective cohort analysis using EHR data in a safety-net system in San Francisco, CA. Participants We included 7384 adult current smokers who had at least three unique primary care encounters with documented smoking status between August 2019 and April 2022. Main measures We assessed four outcomes using multivariate generalized estimating equation models: (1) any cessation attempt, indicating a transition in smoking status from “current smoker” to “former smoker”; (2) sustained cessation, defined as transition in smoking status from current smoker to former smokers for two or more consecutive visits; (3) receipt of smoking cessation counseling from healthcare providers; and (4) receipt of pharmacotherapy. Key Results Of 7384 current adult smokers, 17.6% had made any cessation attempt, and of those 66.5% had sustained cessation. Most patients (81.1%) received counseling and 41.8% received pharmacotherapy. Factors associated with lower odds of any cessation attempt included being aged 45–64, non-Hispanic black, and experiencing homelessness. The factor associated with lower odds of sustained cessation was being male. Factors associated with lower odds of receiving counseling were being insured by Medicaid or being uninsured. Factors associated with lower odds of receiving pharmacotherapy included speaking languages other than English, being male, and identifying as racial and ethnic minorities. Conclusions Health system interventions could close the gap in access to smoking cessation services for unhoused and racial/ethnic minority patients in safety-net settings, thereby increasing cessation among these populations.

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Section: Introductionmentioning

confidence: 70%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“… 19 In the same setting, patients who were older, were insured by Medicaid or uninsured, and had limited English proficiency had a lower likelihood of quit attempts. 20 …”

Section: Introductionmentioning

confidence: 99%

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Factors Associated with Smoking Cessation and the Receipt of Cessation Services in a Public, Safety-Net Primary Care System

Gu,

Rafferty,

Vijayaraghavan

2024

J GEN INTERN MED

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“…The third is an academic primary care clinic located in a safety-net hospital and serves people living with HIV (smoking prevalence 35.4%). We chose these sites based on a needs assessment demonstrating a higher prevalence of tobacco use than the state prevalence of 10% [50] and the presence of an existing clinical infrastructure to deliver guideline-recommended cessation care, including behavioral counseling and pharmacotherapy [51,52]. These clinics have already incorporated a tobacco registry within the Epic EHR to improve delivery of tobacco smoking cessation services by enabling tracking of interventions and missed opportunities in providing cessation care [53].…”

Section: Study Settingmentioning

confidence: 99%

Contingency management to promote smoking cessation in people experiencing homelessness: Leveraging the electronic health record in a pilot, pragmatic randomized controlled trial

et al. 2022

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Background Cigarette smoking is disproportionately high among people experiencing homelessness (PEH). Contingency management (CM) is a strategy that has shown considerable efficacy for smoking cessation and has been used in short-term studies of smoking abstinence in PEH. We describe a pilot, pragmatic randomized controlled trial protocol, which leverages an electronic health record (EHR) infrastructure to assess the feasibility and acceptability of an extended CM intervention to improve long-term abstinence in PEH. Methods We will conduct the study at three safety-net clinics in San Francisco among 90 adults experiencing homelessness who smoke cigarettes currently and have a desire to quit. We will encourage all participants to receive smoking cessation services that include behavioral counseling and pharmacotherapy through their clinics. We will randomly assign participants to an extended CM intervention group with escalating incentives contingent on abstinence or to a control group with fixed incentives for attending study visits. We will use the EHR to recruit participants, track receipt of counseling and pharmacotherapy during clinical care, and communicate with providers on participants’ progress. CM participants will get escalating incentives for demonstration of carbon monoxide-verified abstinence over 6 months, with a total possible earnings of $475. Control participants will receive a fixed incentive of $5 for attending study visits, totaling $125. We will conduct the carbon-monoxide verified abstinence assessments—which will determine CM incentive amounts—daily during week 1, bi-weekly through week 4, weekly through week 13, and monthly through week 24. Measures of feasibility and acceptability, both quantitative and qualitative, will include assessments of screening and recruitment, adherence to study visits, engagement in smoking cessation clinical care, retention, and participant satisfaction. One of the primary clinical outcomes will be biochemically verified 7-day point prevalence abstinence at 6 months. We will measure secondary outcomes, which will include 7-day point prevalence abstinence at 2 weeks, 3 and 12 months. Discussion This trial will allow us to assess the feasibility and acceptability of a CM cessation intervention among PEH. The protocol’s clinical setting and use of EHRs gives it significant potential for scalability. If found to be feasible, acceptable, and subsequently efficacious in a larger trial, the intervention could reduce tobacco-related health disparities by increasing long-term smoking abstinence among this vulnerable population. Trial registration ClinicalTrials.gov NCT04982952. Registered on July 29, 2021.

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Multi-sector Development of Measures and Interventions to Prevent New Smokers Among Youths Living in Underprivileged Housing Projects in Thailand

Ninkron,

Nakamadee,

Mahamit

et al. 2024

J of Prevention

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Factors associated with smoking cessation attempts in a public, safety-net primary care system

Cited by 3 publications

References 40 publications

Factors Associated with Smoking Cessation and the Receipt of Cessation Services in a Public, Safety-Net Primary Care System

Factors Associated with Smoking Cessation and the Receipt of Cessation Services in a Public, Safety-Net Primary Care System

Contingency management to promote smoking cessation in people experiencing homelessness: Leveraging the electronic health record in a pilot, pragmatic randomized controlled trial

Multi-sector Development of Measures and Interventions to Prevent New Smokers Among Youths Living in Underprivileged Housing Projects in Thailand

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