title: Smoking-cessation advice to patients with chronic obstructive pulmonary disease: the critical roles of health insurance and source of care.
abstract: BACKGROUND
  Smoking cessation is the most effective therapeutic intervention for chronic obstructive pulmonary disease (COPD) patients. However, the proportion of smokers with COPD who have received physician advice to quit smoking is unknown. The purpose of this study is to assess the prevalence of receipt of smoking-cessation advice among adults with COPD and explore factors predicting advice receipt.
  
  
  METHODS
  This study employed nationally representative data from the Medical Expenditure Panel Survey (MEPS), collected in 2008-2011 on adults aged ≥20 years. Logistic regression models were conducted to estimate the likelihood of receiving provider advice. Data were analyzed in 2014.
  
  
  RESULTS
  Four percent (95% CI=3.8%, 4.2%) of adults reported being diagnosed with COPD. Among them, 38.5% (95% CI=36.1%, 40.8%) were current smokers. Among those who had seen a physician in the past year, 85.6% (95% CI=83.1%, 88.0%) were advised to quit smoking. Logistic regression revealed negative associations between receipt of smoking-cessation advice and having fewer healthcare visits (AOR=0.41, 95% CI=0.23, 0.72); being uninsured (AOR=0.43, 95% CI=0.22, 0.83); having no usual source of care (AOR=0.39, 95% CI=0.19, 0.80); and having no comorbid chronic diseases (AOR=0.50, 95% CI=0.29, 0.85).
  
  
  CONCLUSIONS
  Having no usual source of care and no health insurance are major barriers to receiving smoking-cessation advice among patients with COPD. The Patient Protection and Affordable Care Act has the potential to increase advice receipt in this high-risk population by expanding health insurance coverage and increasing the number of people with a usual source of care.
authors.affiliation: Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland. Electronic address: ttilert@umd.edu.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Tilert
authors.affiliation: Department of Health Services Administration, School of Public Health, University of Maryland, College Park, Maryland.
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D003376:Counseling / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007348:Insurance, Health; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology