Disparities in Smoking Cessation Assistance n US Primary Care Clinics

Objectives. To examine associations between patient factors and smoking cessation assistance in US safety-net clinics. Methods. Using electronic health record data from the OCHIN network, we identified adults with at least 1 primary care visit to a study clinic (n =143 clinics in 12 states) with at least 1 documented "current smoker' status during 2014 to 2016 (n =136 314; 29.8%). We estimated odds ratios (ORs) of smoking cessation assistance receipt (none [reference], counseling, medication, or both) by patient covariates. Results. For all cessation assistance categories, odds of assistance were higher among women, those with more visits, those assessed and ready to quit, and patients with asthma or chronic obstructive pulmonary disease and hyperlipidemia. Odds of receiving both counseling and medication were lower among uninsured patients (OR = 0.56; 95% confidence interval [CI] = 0.48, 0.64), those of a race/ethnicity other than non-Hispanic White (OR range = 0.65-0.82), and those with diabetes (OR = 0.85; 95% CI = 0.79, 0.92), and higher among older patients and those with a comorbidity, with few exceptions. Conclusions. Disparities in smoking cessation assistance receipt exist in safety-net settings, in particular by health insurance coverage and across race/ethnicity, even after control for other socioeconomic and demographic factors.