Healthcare Visits by Smokers: Does Cessation Treatment Differ Based on Clinical Condition?

Introduction: Persons with behavioral health conditions are disproportionally burdened by their tobacco use. Research is limited on how often this patient population is offered tobacco cessation interventions at healthcare visits. This study examines if cessation treatment offered at healthcare visits differs based on the clinical condition.

Aims and methods: Using data from the 2015 to 2018 National Ambulatory Medical Care Survey, we examined tobacco cessation counseling and medications (bupropion, nicotine replacement therapies, and varenicline) from 4590 visits by patients with current tobacco use. Separate multivariate logistic regressions were used to assess whether the odds of receiving tobacco cessation treatment varied by three groups of clinical conditions: (1) substance use disorder and/or alcohol use disorder, (2) depression, and (3) physical conditions.

Results: The odds of being offered smoking cessation counseling are 4.02 times greater for visits by patients with substance use disorder and/or alcohol use disorder compared to visits by patients with depression (p < .001), while the odds of receiving smoking cessation medication are 2.36 times greater for visits by patients with depression compared to visits by patients with substance use disorder and/or alcohol use disorder (p < .01). Visits by patients with substance use disorder and/or alcohol use disorder have 2.36 times the odds of receiving any combination of tobacco cessation treatment compared to visits by patients with depression (p < .001).

Conclusions: Providers are offering cessation treatment at visits by patients with behavioral health conditions at either higher or comparable rates to those without; however, tobacco cessation treatment continues to be underutilized by providers during office visits.

Implications: The results of our study have implications for increasing educational opportunities for healthcare providers to improve their confidence in offering tobacco cessation treatment to patients with behavioral health conditions. These patients are motivated to quit smoking, yet cessation treatment is underutilized in this population despite having a greater health effect than most other clinical interventions. Incorporating tobacco cessation education in medical school curricula and post-graduate training can help eliminate barriers for physicians to routinely provide cessation assistance. Collaboration between clinicians and behavioral health providers can also enhance tobacco treatment support and improve cessation rates.