Research articleRacial and Ethnic Disparities in Smoking-Cessation Interventions: Analysis of the 2005 National Health Interview Survey
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
References (42)
- et al.
Smoking cessation interventions in U.S. racial/ethnic minority populations: an assessment of the literature
Prev Med
(2003) - et al.
Priorities among effective clinical preventive services: results of a systematic review and analysis
Am J Prev Med
(2006) - et al.
Physician advice about smoking and drinkingAre U.S. adults being informed?
Am J Prev Med
(2003) - et al.
Under-use of smoking-cessation treatments: results from the National Health Interview Survey, 2000
Am J Prev Med
(2005) - et al.
Smoking cessation with and without assistance: a population-based analysis
Am J Prev Med
(2000) - et al.
Latinos report less use of pharmaceutical aids when trying to quit smoking
Am J Prev Med
(2004) - et al.
Views on smoking cessation methods in ethnic minority communities: A qualitative investigation
Prev Med
(2007) - et al.
Reviews of evidence regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke
Am J Prev Med
(2001) - et al.
Health system changes to facilitate the delivery of tobacco-dependence treatment
Am J Prev Med
(2007) - et al.
Does methodology affect the ability to monitor tobacco control activities?Implications for HEDIS and other performance measures
Prev Med
(2003)
Annual smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 1997–2001
MMWR Morb Mortal Wkly Rep
Treating tobacco use and dependence: a clinical practice guideline
Ethnic and racial differences in the smoking-related risk of lung cancer
N Engl J Med 26
Cardiovascular implications of smoking: the surgeon general's point of view
J Health Care Poor Underserved
Eliminating tobacco-related health disparities: directions for future research
Am J Public Health
Tobacco use among U.S. racial/ethnic minority groups—African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics: a report of the Surgeon General
Systematic review: smoking cessation intervention strategies for adults and adults in special populations
Ann Intern Med
Working class matters: socioeconomic disadvantage, race/ethnicity, gender, and smoking in NHIS 2000
Am J Public Health
Physicians' advice to quit smokingThe glass remains half empty
J Fam Pract
Patient smoking cessation advice by health care providers: the role of ethnicity, socioeconomic status, and health
Am J Public Health
Racial/ethnic disparities in report of physician-provided smoking cessation advice: analysis of the 2000 National Health Interview Survey
Am J Public Health
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