Tobacco Use Assessment and Cessation Medication Orders Among Primary Care Patients by Ethnicity, Sex, and Acculturation Indicators.

Abstract

Background: Lung cancer is a leading cause of cancer death among Hispanic men and women in the United States. Smoking rates vary among Hispanic subgroups, with higher rates among those with indicators (e.g., language preference, nativity) of greater acculturation. It is recommended that clinicians ask about tobacco use and provide cessation treatment, as warranted. While studies in health care settings note disparities in tobacco-related care by ethnicity and acculturation proxies, we are unaware of studies that have evaluated these relationships among adult patients within community-based health care clinics (CHCs), key settings for provision of care for Hispanic patients.

Objective: To examine rates of tobacco use assessment and cessation medication orders among Hispanic patients by language and nativity compared to non-Hispanic White patients in CHCs.

Design: Retrospective observational study using electronic health record (EHR) data.

Patients: 1,016,391 adult patients with ≥ 1 primary care visit to a study CHC between 9/1/2020-9/1/2022.

Main outcomes: Outcomes included tobacco use assessment and, among those identified as using tobacco, having a cessation medication ordered. The primary independent variable combined ethnicity and language preference, with sensitivity analyses combining ethnicity and nativity. We used separate generalized estimating equation regressions for each sex to estimate risk differences of each outcome by patient subgroups, adjusting for covariates.

Key results: Compared with non-Hispanic White patients, Spanish-preferring Hispanic males and females and English-preferring Hispanic males had higher rates of having tobacco use assessed (covariate-adjusted risk differences [aRD] = 2.23%, 95% CI = 1.78%-2.69%; 1.74%, 95% CI = 1.35%-2.14%; 0.41%, 95% CI = 0.12%-0.70%, respectively). Ethnicity/nativity analyses found higher rates of tobacco assessment among all Hispanic subgroups. Compared with non-Hispanic White patients, all Hispanic patient subgroups had lower rates of having a cessation medication ordered.

Conclusions: Efforts are needed to inform, develop and test culturally-appropriate and patient-centered interventions for tobacco cessation among Hispanic patients.