Patients With Chronic Disease More Likely to Receive Smoking Cessation Advice

Close up hand breaking the cigarette. Quit smoking concept
Investigators conducted a cross-sectional study to ascertain the disparities between California Latino and non-Latino White smokers with Medicaid insurance regarding smoking cessation.

Daily smokers with frequent doctor visits or diagnosis with chronic disease, are more likely to receive smoking cessation advice and assistance, researchers found in a study published in JAMA Network Open.

They conducted a repeated cross-sectional study, analyzing data from the 2014 and 2016-2018 editions of the California Health Interview Survey (CHIS), which did not include primary outcomes in 2015.

CHIS survey response rate was 44.8% in 2014, 41.5% in 2016, and 42.3% in 2017 and 2018. To be included in the current study, survey respondents had to report having Medi-Cal insurance, identify as Latino or non-Latino White, have seen a clinician in the past year, and be a current smoker.

Current smokers were asked whether a doctor or other health professional in the past year advised them to quit smoking, referred them to a cessation program, or provided them information regarding a cessation program.

Of the 1,861 individuals (aged 39.7±0.79 years) included in the current analysis, 55.2% were non-Latino White, 54.1% were men, and 59.9% had less than a high school education.

Latino smokers were more likely, compared with non-Latino White individuals, to be nondaily smokers, have fewer office visits in the past year, have no chronic disease, have limited English proficiency, and have been born in another country.

More than half of smokers with Medi-Cal who had seen a doctor in the past year (75.1% Latino 81.5% non-Latino White) had not received advice. Nearly 75% had not received assistance to quit smoking.

Latino smokers were less likely to report receiving advice (38.3% vs 55.3%) and assistance (21.8% vs 35.7%) from a health professional compared with non-Latino White smokers.

Those who received advice or assistance were more likely to be aged 50 to 64 years, smoke daily, have at least 1 chronic disease, and visit a doctor at least 5 times in the prior year.

Unadjusted logistic regression analysis indicated race and ethnicity were linked with being advised to quit smoking or referral to or provision of information regarding a cessation program. Non-Latino White smokers were twice as likely compared with Latino smokers to receive advice for quitting smoking and receive assistance.

Adjusted analysis showed no association with race and ethnicity.

Smokers who had at least 1 chronic health condition or visited a doctor at least 5 times in the past year were at least twice as likely (aOR 1.99 95% CI 1.15-3.43; aOR 2.44 95% CI 1.61-3.70) to receive advice for quitting smoking.

Those who smoked daily were 2.3 times more likely to report receiving a referral or cessation information (aOR 2.29 95% CI 1.03-5.13). Daily smoking was not linked with assistance from a health professional to quit smoking.

About 34% of California smokers are Latino and 19.5% are enrolled in state quit-line services, the researchers reported.

Limitations involved generalizability among other Latino groups, such as variation among Latino subgroups or Latino individuals in other areas of the United States, and possible misclassification in self-report.

“Use of strategies to engage tobacco users outside of the clinic, such as proactive outreach and community-based engagement, may help address this disparity,” the researchers noted.

“Future Latino tobacco interventions and population health strategies need to understand the unique smoking behaviors and health care use practices of low-income Latino individuals. The findings may be useful in promoting awareness of these patient-level differences to health care and in informing the design of more targeted studies that can examine the health care system–, clinician-, and patient-level factors in more detail.”


Valencia CV, Dove M, Tong EK. Factors associated with receipt of smoking cessation advice and assistance by health professionals among Latino and non-Latino White smokers with Medicaid insurance in California. JAMA Network Open. Published online January 19, 2022. doi:10.1001/jamanetworkopen.2021.44207