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    Original Investigation
    Substance Use and Addiction
    May 24, 2019

    National Trends in Cessation Counseling, Prescription Medication Use, and Associated Costs Among US Adult Cigarette Smokers

    Author Affiliations
    • 1St Luke’s Hospital, Department of Medicine, Chesterfield, Missouri
    • 2Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
    • 3Department of Internal Medicine, East Carolina University, Greenville, North Carolina
    • 4Department of Medicine, New York Presbyterian-Weill Cornell Medical College, New York
    • 5Department of Medicine, Johns Hopkins University, Baltimore, Maryland
    • 6Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
    • 7Division of Cardiology, University of Louisville, Louisville, Kentucky
    JAMA Netw Open. 2019;2(5):e194585. doi:10.1001/jamanetworkopen.2019.4585
    Key Points español 中文 (chinese)

    Question  What are the 10-year trends in the delivery of cigarette smoking cessation services for adult smokers in the United States?

    Findings  In this cross-sectional study of 29 106 US adult smokers from 2006 to 2015, the proportion who reported receiving physician advice to quit smoking increased and the use of prescription cessation medication decreased with a corresponding reduction in expenditures. Lower rates of cessation services were observed in certain populations, including men, younger adults, uninsured individuals, racial/ethnic minority groups, and those without smoking-related comorbidities.

    Meaning  The disparities in the delivery of known smoking cessation services among certain subgroups may be associated with higher smoking rates despite an all-time low prevalence of smoking, suggesting the call for a more targeted implementation of smoking cessation guidelines.


    Importance  Cigarette smoking is the leading cause of preventable disease and death in the United States. When used separately or in combination, smoking cessation counseling and cessation medications have been associated with increased cessation rates.

    Objectives  To present trends in self-reported receipt of physician advice to quit smoking and in use of prescription smoking cessation medication along with their associated expenditures among a nationally representative sample of active adult smokers in the United States.

    Design, Setting, and Participants  This repeated cross-sectional study of US adults aged 18 years or older was conducted from July 5, 2018, through August 15, 2018. Data were collected between January 1, 2006, and December 31, 2015, from the Medical Expenditure Panel Survey, an annual US survey of individuals and families, health care personnel, and employers. Participants (n = 29 106) were noninstitutionalized civilians who were randomly drawn from the respondents of the previous year’s National Health Interview Survey. Multivariable logistic regression models were used to examine the associations between sociodemographic factors and receipt of physician cessation advice and use of cessation prescription medication. A 2-part econometric model was used to assess health care expenditures.

    Main Outcomes and Measures  Trends in self-reported receipt of physician advice to quit and uptake of prescription smoking cessation medications with associated total and out-of-pocket expenditures.

    Results  The study sample consisted of 29 106 participants, with a mean (SD) age of 57 (10) years and a composition of 13 670 women (47.0%). The results were weighted to provide estimates for 31.2 million active adult cigarette smokers. The proportion of smokers who reported receiving physician advice to quit increased from 60.2% (95% CI, 58.5%-62.0%) in 2006 to 2007 to 64.9% (95% CI, 62.8%-66.9%) in 2014 to 2015, with a P for trend = .001. The odds of receiving physician cessation advice was statistically significantly higher in women (odds ratio [OR], 1.50; 95% CI, 1.39-1.59) and lower among uninsured participants (OR, 0.58; 95% CI, 0.52-0.65). Overall, prescription smoking cessation medication use decreased with a corresponding reduction in total expenditures from $146 million (out-of-pocket cost, $46 million) in 2006 to 2007 to $73 million (out-of-pocket cost, $9 million) in 2014 to 2015. Male (odds ratio [OR], 0.78; 95% CI, 0.66-0.91), uninsured (OR, 0.58; 95% CI, 0.41-0.83), and racial/ethnic minority (African American: OR, 0.51 [95% CI, 0.38-0.69]; Asian: OR, 0.31 [95% CI, 0.10-0.93]; Hispanic: OR, 0.53 [95% CI, 0.36-0.78]) participants were less likely to use prescription smoking cessation medications.

    Conclusions and Relevance  The lower rates of delivery of physician advice to quit smoking and the lower uptake of known prescription smoking cessation medications among men, younger adults, uninsured individuals, racial/ethnic minority groups, and those without smoking-associated comorbidities may be associated with the higher smoking rates among these subgroups despite an all-time low prevalence of smoking in the United States; this finding calls for a more targeted implementation of smoking cessation guidelines.