Disparities in US Healthcare Provider Screening and Advice for Cessation Across Chronic Medical Conditions and Tobacco Products
Open accessAbstract
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.
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Mental health professionals may lack knowledge of and experience with tobacco treatments for encouraging and supporting cessation for this population.
“Moreover, mental health professionals may lack knowledge of and experience with tobacco treatments for encouraging and supporting cessation for this population [30, 31].”
From Can an Acceptance and Commitment Therapy-Based Smartphone App Help Individuals with Mental Health Disorders Quit Smoking? (2024) · cites this paper as [30]
The Discussion reports that healthcare providers do not adequately address tobacco use among adults with mental health and substance use disorders and recommends physician training to improve cessation support. It does not establish that mental health professionals specifically lack knowledge of, or experience with, tobacco treatments. (LLM, conf=0.78)
Experimental — accuracy not yet measuredSmoking is often not addressed (assessed or integrated into treatment) in mental health treatment facilities.
“There is also widespread evidence that smoking is often not addressed (e.g., assessed or integrated into treatment) in mental health treatment facilities [29, 30].”
From Can an Acceptance and Commitment Therapy-Based Smartphone App Help Individuals with Mental Health Disorders Quit Smoking? (2024) · cites this paper as [30]
The Discussion (page unavailable) reports that adults with mental health and substance use disorders were no more likely to be screened for tobacco use than adults without a condition, and describes their tobacco use as inadequately addressed by healthcare providers. The study concerns provider screening and advice among US adults; it does not establish how often smoking is assessed or integrated into care specifically in mental health treatment facilities. (LLM, conf=0.87)
Experimental — accuracy not yet measured
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“Moreover, mental health professionals may lack knowledge of and experience with tobacco treatments for encouraging and supporting cessation for this population [30, 31].”
- Authors
- Keith, D. R., Stanton, C. A., Gaalema, D. E., Bunn, J. Y., Doogan, N. J., Redner, R., Kurti, A. N., Cepeda-Benito, A., Lopez, A. A., Morehead, A. L., Roberts, M. E., & Higgins, S. T.
- Affiliations
- University of Vermont (US)
- Westat (United States) (US)
- The Ohio State University (US)
- Southern Illinois University Carbondale (US)
- Corresponding author
- Keith, Diana R.
- ORCID
- Venue
- Journal of General Internal Medicine
- Published
- 2017-05-03
- Volume
- 32
- Issue
- 9
- Pages
- 974-980
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC5570737
- OpenAlex
- W2610643457
- Cited by
- 36
- References
- 35
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 3 · 2023: 8 · 2022: 3 · 2021: 4 · 2020: 6 · 2019: 2 · 2018: 5 · 2017: 1
- FWCI
- 2.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of General Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Drug Abuse (T32-DA-07242, T32DA007242)
- National Institute of General Medical Sciences (T32DA07242, P20GM103644)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- tobacco use disparities, tobacco use screening, smoking cessation counseling, chronic disease, non-cigarette tobacco products, cigars, smokeless tobacco, cigarette smoking, mental illness, substance use disorders, provider communication, tobacco cessation interventions
- MeSH terms
- Smokers, Adult, Chronic Disease, Cross-Sectional Studies, Female, Health Surveys, Humans, Male, Mass Screening, Professional-Patient Relations, Surveys and Questionnaires, Risk Factors, Smoking, United States, Comorbidity, Prevalence, Logistic Models, Case-Control Studies, Smoking Cessation, Healthcare Disparities, Self Report, Tobacco Products
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