Disparities in US Healthcare Provider Screening and Advice for Cessation Across Chronic Medical Conditions and Tobacco Products
Disparities in US Healthcare Provider Screening and Advice for Cessation Across Chronic Medical Conditions and Tobacco Products
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DOI：
10.1007/s11606-017-4062-6
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发表时间：
2017-09-01
影响因子：
5.7
通讯作者：
Higgins, Stephen T.
中科院分区：
文献类型：
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作者：
Keith, Diana R.;Stanton, Cassandra A.;Higgins, Stephen T.
在美国，烟草使用的差异正在恶化，对慢性病患者的影响不成比例。一个可能的原因是，医生可能不会筛选和建议戒烟统一的病人和/或烟草产品。这项研究探讨了供应商的沟通，有关香烟和非香烟烟草产品的成人慢性疾病。（2013-2014年）的国家药物使用和健康调查。（18岁）在过去一年中使用烟草。烟草使用的流行率包括过去一年使用香烟，雪茄，或无烟烟草在那些有和没有慢性疾病。慢性疾病包括哮喘、焦虑、冠心病、抑郁、糖尿病、肝炎、艾滋病毒、高血压、肺癌、中风和药物滥用。报告了不同慢性病和烟草产品类型接受筛查和戒烟建议的优势比。使用逻辑回归分析数据，控制基本的社会人口因素和提供者访问次数。患有焦虑、抑郁和物质使用障碍的成年人在过去一年中吸烟（37.2-58.2%）、雪茄（9.1-28.0%）和无烟烟草（3.1-11.7%）的患病率最高。患有任何慢性疾病的患者比没有疾病的患者更有可能接受戒烟建议（OR 1.21-2.37，p < 0.01），尽管患有精神健康和物质使用障碍的成年人的几率最低（OR 1.21-1.35，p < 0.01）。吸烟者比非吸烟者更有可能报告接受筛查并被建议戒烟（OR 1.54-5.71，p < 0.01）。结果支持需要对提供者进行培训，以扩大筛查和戒烟干预措施，将越来越多的烟草产品纳入其中。对于那些患有精神健康和药物使用障碍的人，特别需要进行筛查和转诊，以减少烟草相关疾病和死亡的不同负担。
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.This study examined provider communications regarding cigarette and non-cigarette tobacco products among adults with chronic conditions.Cross-sectional study drawn from two waves (2013-2014) of the National Survey on Drug Use and Health (NSDUH).Adults ( 18 years) who used tobacco in the past year.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.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).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.