Gender and age disparities for smoking-cessation treatment.
BACKGROUND
Physicians play a critical role in tobacco-dependence treatment, especially prescribing cessation medications. However, it is unclear whether efforts are meeting recommended standards. This study evaluates the frequency and predictors of tobacco-use identification, counseling for tobacco dependence, and the prescription of cessation medications in a nationally representative sample of physician-patient encounters.


METHODS
More than 58,000 physician-patient ambulatory encounters from the National Ambulatory Medical Care Survey 2001 and 2002 were analyzed in 2004-2005, including patient demographics, diagnoses, tobacco counseling, and prescriptions.


RESULTS
Tobacco-use status was identified in 69% of patient encounters, with 16% of those encounters indicating current use. Tobacco counseling occurred in 22.5% of visits by tobacco users, and 2.4% of tobacco users were prescribed cessation medications. These rates are similar to previous analyses in 1991. Patient characteristics associated with being more likely to receive counseling include being a new patient (adjusted odds ratio [OR]=1.34, 95% confidence interval [CI]=1.00-1.77) and having a tobacco-caused diagnosis (OR=2.71, CI=1.95-3.78). Characteristics associated with a lower likelihood of receiving medication include female gender (OR=0.45, CI=0.22-0.90) and age 65 and above (OR=0.14, CI=0.03-0.63), while a tobacco-caused diagnosis (OR=3.91, CI=1.64-9.29) and patient prompting (OR=15.31, CI=3.36-69.8) were associated with higher likelihood of receiving medications.


CONCLUSIONS
Despite increasing national attention, the identification of tobacco status, counseling rates, and the use of cessation medications by physicians are low and unchanged from 1991. Women and elderly tobacco users were much less likely to receive prescriptions for cessation medications, while patients requesting treatment and those with tobacco-caused diagnoses were more likely. Further educational and public health campaigns are needed to encourage the use of these effective medications, especially in women and the elderly.
Steinberg
Michael B
MB
University of Medicine and Dentistry of New Jersey, Division of General Internal Medicine, New Brunswick, 08903, USA. michael.steinberg@umdnj.edu
Akincigil
Ayse
A
Delnevo
Cristine D
CD
Crystal
Stephen
S
Carson
Jeffrey L
JL
D000328:Adult; D017677:Age Distribution; D000368:Aged; D005260:Female; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D015995:Prevalence; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology; D016540:Smoking Cessation / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology