eAppendix. Supplemental Methods
eTable. Variables Included in Analysis With Frequencies Reported
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Maki KG, Volk RJ. Disparities in Receipt of Smoking Cessation Assistance Within the US. JAMA Netw Open. 2022;5(6):e2215681. doi:10.1001/jamanetworkopen.2022.15681
Although tobacco use has decreased in recent decades, there are disparities related to its use and receipt of cessation assistance.1 Our objective was to analyze sociodemographic variations in receiving cessation assistance from health professionals (HPs) by individuals who reported smoking, or quitting, within the past year.
We used cross-sectional data from the 2020 National Health Interview Survey.2,3 Our study used a publicly available, anonymized database; thus, it was exempt from institutional review board oversight and the need for informed consent, in accordance with 45 CFR §46. This study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline. For additional information on our methods, see the eAppendix and eTable in the Supplement.
Our outcome focused on the following item, “In the past 12 months, has a doctor, dentist, or other health professional advised you about ways to stop smoking or prescribed medication to help you quit?” Study interviewers asked this question of adults who saw an HP within the past year and reported currently, or quitting, smoking in the past year.
We also included sociodemographic characteristics and health-related indicators in our analysis. We included participants’ self-reported race and ethnicity because of these factors’ associations with smoking disparities.1
We used the survey package in RStudio statistical software version 1.4.1106 (R Project for Statistical Computing) to account for the complex sampling design and weighting. We used hierarchical multivariable logistic regression to assess the association between variables, with a significance level of P < .05 (2-sided). Data analysis was performed in February 2022.
Our sample (weighted number, 25 856 639 individuals; mean [SD] age, 48.38 [15.84] years; 12 849 072 female individuals) included individuals who had seen an HP and smoked currently, or quit, in the past year. There were higher odds of receiving cessation assistance for respondents who were aged 70 to 79 years compared with those younger than 30 years (odds ratio [OR], 2.18; 95% CI, 1.09-4.34), for respondents in medium-to-small metropolitan areas compared with nonmetropolitan regions (OR, 1.63; 95% CI, 1.17-2.29), for those who have 1 or more places to receive preventive care compared with those with no usual place (OR, 2.31; 95% CI, 1.35-4.03), for respondents who had a cessation attempt in the past year compared with those who did not (OR, 1.53; 95% CI, 1.16-2.00), and for those who had received a chronic obstructive pulmonary disease diagnosis compared to those who had not received a diagnosis (OR, 1.60; 95% CI, 1.15-2.25) (Table).
There were significantly lower odds of receiving cessation assistance for those in the Southern (OR, 0.65; 95% CI, 0.46-0.91) and Western regions (OR, 0.66; 95% CI, 0.45-0.98), compared with the Northeast, and for those without health insurance compared with those who have private insurance (OR, 0.60; 95% CI, 0.38-0.94). Results are summarized in the Table.
In this cross-sectional study, we found several disparities in receipt of cessation assistance reported by US adults who smoke, including region of the US, urban vs rural categorization, health insurance status, and having a usual place to receive preventive care. These findings highlight the pervasiveness of disparities associated with smoking cessation assistance based on sociodemographic variables.1,4-6
Although we saw an increased likelihood in receiving cessation assistance for respondents who had received a diagnosis of chronic obstructive pulmonary disease or similar conditions, our results did not show differences for those who had received a diagnosis of cancer. Similarly, there were no differences based on smoking pack-year history or estimated eligibility for lung cancer screening among those who currently smoke (pack-year information for former smoking is not available in this data set).
There were some limitations to this study. The data were collected as part of a national survey and may be prone to self-report bias. We also are not able to ascertain the type of HP who provided cessation assistance or its frequency. In addition, the data are cross-sectional and cannot be used to establish causal inferences.
Our study’s results highlight areas where sociodemographic gaps in receipt of smoking cessation assistance persist, including age, geographical region, and access to care. Future efforts should be focused to help mitigate tobacco-related disparities.
Accepted for Publication: April 20, 2022.
Published: June 1, 2022. doi:10.1001/jamanetworkopen.2022.15681
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Maki KG et al. JAMA Network Open.
Corresponding Author: Robert J. Volk, PhD, Department of Health Services Research, MD Anderson Cancer Center, University of Texas, 1515 Holcombe Blvd, Unit 437, Houston, TX 77030 (email@example.com).
Author Contributions: Drs Maki and Volk had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Both authors.
Acquisition, analysis, or interpretation of data: Maki.
Drafting of the manuscript: Maki.
Critical revision of the manuscript for important intellectual content: Both authors.
Statistical analysis: Maki.
Obtained funding: Volk.
Conflict of Interest Disclosures: Dr Maki was supported by a cancer prevention fellowship that was supported by the Cancer Prevention and Research Institute of Texas (grant award RP170259; Shine Chang, PhD, Principal Investigator) and by the MD Anderson Cancer Center (support grant CA016672 funded by the National Cancer Institute) outside the submitted work. No other disclosures were reported.
Funding/Support: This study was supported by the Cancer Prevention and Research Institute of Texas (grant RP190210) and The University of Texas MD Anderson’s Cancer Center (support grant funded from National Institutes of Health, National Cancer Institute under award number P30CA016672, using the Shared Decision Making Core and Clinical Protocol and Data Management System).
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Information: The data used in this analysis are publicly available through the National Health Interview Survey.