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

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.

Receiving family physician's advice and the 'stages of change' in smoking cessation among Arab minority men in Israel

BACKGROUND

Receiving physician advice (PA) can increase patient's willingness to quit smoking and influence the 'stages of change' in quitting. However, less is known about this association among minority groups for whom cessation is more challenging.

OBJECTIVE

We examined whether receiving advice on smoking cessation from a family physician is associated with the 'stages of change' in quitting smoking-i.e. pre-contemplation, contemplation, preparation or action-among Arab minority men in Israel with high smoking prevalence.

METHODS

In 2011-12, a stratified random sample of 964 Arab men current and past smokers, aged 18-64, were interviewed face-to-face. We used ordered logistic regression models to examine the association between PA and stages of quitting smoking, adjusted for socioeconomic status, health status, sociodemographics, Health Maintenance Organizations (HMO) and smoking-related variables.

RESULTS

About 40% of Arab men reported ever receiving PA to quit smoking. Participants with chronic disease(s) and higher nicotine dependence were more likely to receive PA. PA was significantly associated with the stages of change, but not with actual quitting. In multivariable analysis, receiving PA was associated with a greater likelihood of being at the contemplation or preparation stages of cessation, compared to pre-contemplation; odds ratio (OR) and 95% confidence interval (CI) were 1.95 (95% CI = 1.34-2.85) and 1.14 (95% CI = 1.09-2.076), respectively.

CONCLUSIONS

Receiving PA among minority men is associated with advanced motivational stages of change in quitting smoking, but not with actual smoking cessation. Culturally, sensitive interventions and involvement of other health care providers may be considered for more comprehensive smoking cessation, in addition to PA.

Predictors of attempted weight loss and physician advice for weight loss in a group of overweight and obese patients in Togo

Despite a worldwide increase in obesity, little is known about obesity in Africa and factors related to attempting weight loss (AWL) in high-risk populations. The aims of this study were to determine the prevalence of obesity among patients in a Togolese cardiology clinic and determine predictors of reporting AWL and physician advice for weight loss. We recruited French-speaking men and women, aged > or = 18 years from this academic cardiology clinic to complete a questionnaire and anthropometric measurements. Among 135 patients, 33% were overweight and 24% were obese. Among overweight and obese patients (n = 76), logistic regression was used to calculate odds ratios (OR) for predictors of AWL and physician advice. 53% reported AWL and 49% received physician advice. Obese participants were 11 times more likely than overweight participants to report AWL (OR = 11.14; P < .0001). AWL was more common in those reporting physician advice (OR = 7.58; P = .0001) and women (OR = 2.78; P = .04). Obesity and female sex were also associated with reporting physician advice to lose weight. Age and education were not associated with AWL or physician advice. Physician advice highly correlates with AWL; however only half of participants received it. Physicians should make efforts to incorporate weight loss advice in their routine care.