Research article
Racial and Ethnic Disparities in Smoking-Cessation Interventions: Analysis of the 2005 National Health Interview Survey

https://doi.org/10.1016/j.amepre.2008.02.003Get rights and content

Background

Recent national surveys document racial and ethnic disparities in receipt of smoking-cessation advice. This study updates and expands prior analyses using survey data for 2005, and evaluates the association between smokers' race and ethnicity and three separate measures of healthcare-encounter–based tobacco interventions: screening, smoking-cessation advice, and use of smoking-cessation aids.

Methods

Analyses are based on 4756 smokers (aged 18 and older) reporting a healthcare encounter within the past year who participated in the 2005 National Health Interview Survey (NHIS). Multivariate-adjusted OR and 95% CI for receipt of tobacco interventions in non-Hispanic black and Hispanic smokers were compared to those of non-Hispanic white smokers, adjusted for smokers' characteristics (sociodemographics, health status, and healthcare-utilization factors, and smoking-related characteristics). Analyses were done in 2006.

Results

Results show that compared to white smokers, black and Hispanic smokers had significantly lower odds of (1) being asked about tobacco use (AOR=0.70 and AOR=0.69, respectively); (2) being advised to quit (AOR=0.72 and AOR=0.64, respectively); or (3) having used tobacco-cessation aids during the past year in a quit attempt (AOR=0.60 and AOR=0.59, respectively). Compared to 2000 NHIS published data, the prevalence of receipt of advice to quit from a healthcare provider increased from 52.9% in 2000 to 61.2% in 2005, with increases across racial and ethnic groups.

Conclusions

Despite progress in smokers' being advised to quit during healthcare encounters in the past 5 years, black and Hispanic smokers continue to be less likely than whites to receive and use tobacco-cessation interventions, even after control for socioeconomic and healthcare factors. Further actions are needed to understand and eliminate this disparity.

Introduction

Cigarette smoking is associated with substantial morbidity and mortality, and remains a considerable threat to public health. While tobacco use in the U.S. has been decreasing overall, each year it is associated with 438,000 premature deaths and $92 billion in productivity losses.1 Almost one third of all tobacco users will die prematurely because of their use of tobacco,2 and members of racial and ethnic minority populations bear a disproportionate share of the adverse health consequences of tobacco use.3, 4, 5 There is a national imperative to help smokers quit smoking and eliminate tobacco-related health disparities.5, 6

Effective treatment options for nicotine dependence range from brief advice to quit from a healthcare provider to extensive counseling and the use of pharmaceutical and behavioral adjuncts.2 There is strong evidence that such interventions can considerably improve cessation rates in smokers.2 Although there have been fewer cessation trials targeted to minority smokers,7 these studies have demonstrated the efficacy of a variety of smoking-cessation treatments for black and Hispanic smokers.8 Clinical guidelines for screening and counseling smokers published by the U.S. DHHS have been recommended as part of standard care to promote cessation.2 The identification and counseling of smokers is among the most consequential and cost-effective intervention in clinical practice.9

Smoking is associated with socioeconomic disadvantage and is an important contributor to inequalities in health.5, 10 Most smokers, regardless of race or ethnicity, want to quit, and would benefit from assistance received from their medical providers.10 Previous reports,11, 12, 13, 14 including two based on national population-based surveys conducted in 2000, show that black or Hispanic smokers are less likely to receive a healthcare provider's advice to quit than are their white counterparts. Similarly, the 2003 Medical Expenditures Panel Survey15 found that 62% of non-Hispanic black smokers and 54% of Hispanic smokers who had a routine medical checkup in the past year were counseled by a medical provider to stop smoking, compared to 67% of non-Hispanic white smokers. Although there have been modest increases over the past decade in the use of smoking-cessation treatments among smokers trying to quit,16, 17 few studies have assessed how the use of smoking-cessation treatments vary by race and ethnicity. Reports based on clinic and regional surveys suggest that racial and ethnic minorities are less likely to use effective cessation treatments (pharmacological or behavioral methods).18, 19, 20 Understanding racial and ethnic differences in the provision or utilization of smoking-cessation interventions is an important component of efforts to reduce tobacco use among minorities.

Section snippets

Methods

This study used national population-based data from the 2005 National Health Interview Survey (NHIS) to describe racial and ethnic variations in tobacco-use assessment, healthcare provider advice to quit, and use of cessation aids by smokers who had a healthcare encounter in the past year. To assess changes in the receipt of cessation interventions, findings were compared with those previously reported based on the 2000 NHIS.13

The NHIS is an annual cross-sectional, face-to-face,

Results

Results from descriptive analysis show that there were significant differences in sociodemographic, health-related, and smoking-related characteristics among non-Hispanic whites, non-Hispanic blacks, and Hispanic smokers with a healthcare encounter in the past year (Table 1). Compared to non-Hispanic whites, non-Hispanic blacks and Hispanic smokers had lower levels of educational attainment, were more likely to live in households with incomes under 200% of poverty, and were more likely to be

Discussion

The principal finding of this study is that in 2005, significantly lower proportions of non-Hispanic black and Hispanic smokers who had healthcare encounters in the past year were screened for tobacco use, were advised to quit smoking by a healthcare provider, or used cessation aids than were white smokers. These disparities persisted in analyses that controlled for available sociodemographic, health-related, and smoking related covariates that vary by race/ethnicity and are associated with

Conclusion

Despite improvements in the percentage of smokers who received tobacco-cessation interventions during healthcare encounters between 2000 and 2005, overall performance is still less than optimal, particularly for some subgroups of the population. In particular, non-Hispanic black and Hispanic smokers are less likely than non-Hispanic white smokers to receive advice to quit smoking and to use smoking-cessation treatments in quit attempts. Additional research is needed to document the role of

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