Disparities in knowledge and use of tobacco treatment among smokers in California following healthcare reform

Kelly C. Young-Wolff, Sara R. Adams, Andy S.L. Tan, Alyce S. Adams, Daniella Klebaner, Cynthia I. Campbell, Derek D. Satre, Ramzi G. Salloum, Lisa Carter-Harris, Judith J. Prochaska

Research output: Contribution to journalArticle

Abstract

The Affordable Care Act (ACA) promised to narrow smoking disparities by expanding access to healthcare and mandating comprehensive coverage for tobacco treatment starting in 2014. We examined whether two years after ACA implementation disparities in receiving clinician advice to quit and smokers' knowledge and use of treatment resources remained. We conducted telephone interviews in 2016 with a stratified random sample of self-reported smokers newly enrolled in the Kaiser Permanente Northern California's (KPNC) integrated healthcare delivery system in 2014 (N = 491; 50% female; 53% non-white; 6% Spanish language). We used Poisson regression with robust standard errors to test whether sociodemographics, insurance type, comorbidities, smoking status in 2016 (former, light/nondaily [<5 cigarettes per day], daily), and preferred language (English or Spanish) were associated with receiving clinician advice to quit and knowledge and use of tobacco treatment. We included an interaction between smoking status and language to test whether the relation between smoking status and key outcomes varied with preferred language. Overall, 80% of respondents received clinician advice to quit, 84% knew that KPNC offers cessation counseling, 54% knew that cessation pharmacotherapy is free, 54% used pharmacotherapy, and 6% used counseling. In multivariate models, Spanish-speaking light/nondaily smokers had significantly lower rates of all outcomes, while there was no association with other demographic and clinical characteristics. Following ACA implementation, most smokers newly enrolled in KPNC received clinician advice to quit and over half used pharmacotherapy, yet counseling utilization was low. Spanish-language outreach efforts and treatment services are recommended, particularly for adults who are light/nondaily smokers.

Original languageEnglish (US)
Article number100847
JournalPreventive Medicine Reports
Volume14
DOIs
StatePublished - Jun 1 2019
Externally publishedYes

Fingerprint

Health Care Reform
Tobacco Use
Patient Protection and Affordable Care Act
Language
Smoking
Counseling
Light
Drug Therapy
Integrated Delivery of Health Care
Comprehensive Health Care
Delivery of Health Care
Language Tests
Therapeutics
Insurance
Tobacco Products
Tobacco
Comorbidity
Demography
Interviews

Keywords

  • Affordable Care Act
  • Disparities
  • Health reform
  • Light smokers
  • Non-daily smokers
  • Smoking
  • Spanish-speaking

ASJC Scopus subject areas

  • Health Informatics
  • Public Health, Environmental and Occupational Health

Cite this

Young-Wolff, K. C., Adams, S. R., Tan, A. S. L., Adams, A. S., Klebaner, D., Campbell, C. I., ... Prochaska, J. J. (2019). Disparities in knowledge and use of tobacco treatment among smokers in California following healthcare reform. Preventive Medicine Reports, 14, [100847]. https://doi.org/10.1016/j.pmedr.2019.100847

Disparities in knowledge and use of tobacco treatment among smokers in California following healthcare reform. / Young-Wolff, Kelly C.; Adams, Sara R.; Tan, Andy S.L.; Adams, Alyce S.; Klebaner, Daniella; Campbell, Cynthia I.; Satre, Derek D.; Salloum, Ramzi G.; Carter-Harris, Lisa; Prochaska, Judith J.

In: Preventive Medicine Reports, Vol. 14, 100847, 01.06.2019.

Research output: Contribution to journalArticle

Young-Wolff, KC, Adams, SR, Tan, ASL, Adams, AS, Klebaner, D, Campbell, CI, Satre, DD, Salloum, RG, Carter-Harris, L & Prochaska, JJ 2019, 'Disparities in knowledge and use of tobacco treatment among smokers in California following healthcare reform', Preventive Medicine Reports, vol. 14, 100847. https://doi.org/10.1016/j.pmedr.2019.100847
Young-Wolff, Kelly C. ; Adams, Sara R. ; Tan, Andy S.L. ; Adams, Alyce S. ; Klebaner, Daniella ; Campbell, Cynthia I. ; Satre, Derek D. ; Salloum, Ramzi G. ; Carter-Harris, Lisa ; Prochaska, Judith J. / Disparities in knowledge and use of tobacco treatment among smokers in California following healthcare reform. In: Preventive Medicine Reports. 2019 ; Vol. 14.
@article{46a9f043a66145288c6474270b856b2e,
title = "Disparities in knowledge and use of tobacco treatment among smokers in California following healthcare reform",
abstract = "The Affordable Care Act (ACA) promised to narrow smoking disparities by expanding access to healthcare and mandating comprehensive coverage for tobacco treatment starting in 2014. We examined whether two years after ACA implementation disparities in receiving clinician advice to quit and smokers' knowledge and use of treatment resources remained. We conducted telephone interviews in 2016 with a stratified random sample of self-reported smokers newly enrolled in the Kaiser Permanente Northern California's (KPNC) integrated healthcare delivery system in 2014 (N = 491; 50{\%} female; 53{\%} non-white; 6{\%} Spanish language). We used Poisson regression with robust standard errors to test whether sociodemographics, insurance type, comorbidities, smoking status in 2016 (former, light/nondaily [<5 cigarettes per day], daily), and preferred language (English or Spanish) were associated with receiving clinician advice to quit and knowledge and use of tobacco treatment. We included an interaction between smoking status and language to test whether the relation between smoking status and key outcomes varied with preferred language. Overall, 80{\%} of respondents received clinician advice to quit, 84{\%} knew that KPNC offers cessation counseling, 54{\%} knew that cessation pharmacotherapy is free, 54{\%} used pharmacotherapy, and 6{\%} used counseling. In multivariate models, Spanish-speaking light/nondaily smokers had significantly lower rates of all outcomes, while there was no association with other demographic and clinical characteristics. Following ACA implementation, most smokers newly enrolled in KPNC received clinician advice to quit and over half used pharmacotherapy, yet counseling utilization was low. Spanish-language outreach efforts and treatment services are recommended, particularly for adults who are light/nondaily smokers.",
keywords = "Affordable Care Act, Disparities, Health reform, Light smokers, Non-daily smokers, Smoking, Spanish-speaking",
author = "Young-Wolff, {Kelly C.} and Adams, {Sara R.} and Tan, {Andy S.L.} and Adams, {Alyce S.} and Daniella Klebaner and Campbell, {Cynthia I.} and Satre, {Derek D.} and Salloum, {Ramzi G.} and Lisa Carter-Harris and Prochaska, {Judith J.}",
year = "2019",
month = "6",
day = "1",
doi = "10.1016/j.pmedr.2019.100847",
language = "English (US)",
volume = "14",
journal = "Preventive Medicine Reports",
issn = "2211-3355",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Disparities in knowledge and use of tobacco treatment among smokers in California following healthcare reform

AU - Young-Wolff, Kelly C.

AU - Adams, Sara R.

AU - Tan, Andy S.L.

AU - Adams, Alyce S.

AU - Klebaner, Daniella

AU - Campbell, Cynthia I.

AU - Satre, Derek D.

AU - Salloum, Ramzi G.

AU - Carter-Harris, Lisa

AU - Prochaska, Judith J.

PY - 2019/6/1

Y1 - 2019/6/1

N2 - The Affordable Care Act (ACA) promised to narrow smoking disparities by expanding access to healthcare and mandating comprehensive coverage for tobacco treatment starting in 2014. We examined whether two years after ACA implementation disparities in receiving clinician advice to quit and smokers' knowledge and use of treatment resources remained. We conducted telephone interviews in 2016 with a stratified random sample of self-reported smokers newly enrolled in the Kaiser Permanente Northern California's (KPNC) integrated healthcare delivery system in 2014 (N = 491; 50% female; 53% non-white; 6% Spanish language). We used Poisson regression with robust standard errors to test whether sociodemographics, insurance type, comorbidities, smoking status in 2016 (former, light/nondaily [<5 cigarettes per day], daily), and preferred language (English or Spanish) were associated with receiving clinician advice to quit and knowledge and use of tobacco treatment. We included an interaction between smoking status and language to test whether the relation between smoking status and key outcomes varied with preferred language. Overall, 80% of respondents received clinician advice to quit, 84% knew that KPNC offers cessation counseling, 54% knew that cessation pharmacotherapy is free, 54% used pharmacotherapy, and 6% used counseling. In multivariate models, Spanish-speaking light/nondaily smokers had significantly lower rates of all outcomes, while there was no association with other demographic and clinical characteristics. Following ACA implementation, most smokers newly enrolled in KPNC received clinician advice to quit and over half used pharmacotherapy, yet counseling utilization was low. Spanish-language outreach efforts and treatment services are recommended, particularly for adults who are light/nondaily smokers.

AB - The Affordable Care Act (ACA) promised to narrow smoking disparities by expanding access to healthcare and mandating comprehensive coverage for tobacco treatment starting in 2014. We examined whether two years after ACA implementation disparities in receiving clinician advice to quit and smokers' knowledge and use of treatment resources remained. We conducted telephone interviews in 2016 with a stratified random sample of self-reported smokers newly enrolled in the Kaiser Permanente Northern California's (KPNC) integrated healthcare delivery system in 2014 (N = 491; 50% female; 53% non-white; 6% Spanish language). We used Poisson regression with robust standard errors to test whether sociodemographics, insurance type, comorbidities, smoking status in 2016 (former, light/nondaily [<5 cigarettes per day], daily), and preferred language (English or Spanish) were associated with receiving clinician advice to quit and knowledge and use of tobacco treatment. We included an interaction between smoking status and language to test whether the relation between smoking status and key outcomes varied with preferred language. Overall, 80% of respondents received clinician advice to quit, 84% knew that KPNC offers cessation counseling, 54% knew that cessation pharmacotherapy is free, 54% used pharmacotherapy, and 6% used counseling. In multivariate models, Spanish-speaking light/nondaily smokers had significantly lower rates of all outcomes, while there was no association with other demographic and clinical characteristics. Following ACA implementation, most smokers newly enrolled in KPNC received clinician advice to quit and over half used pharmacotherapy, yet counseling utilization was low. Spanish-language outreach efforts and treatment services are recommended, particularly for adults who are light/nondaily smokers.

KW - Affordable Care Act

KW - Disparities

KW - Health reform

KW - Light smokers

KW - Non-daily smokers

KW - Smoking

KW - Spanish-speaking

UR - http://www.scopus.com/inward/record.url?scp=85064322997&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85064322997&partnerID=8YFLogxK

U2 - 10.1016/j.pmedr.2019.100847

DO - 10.1016/j.pmedr.2019.100847

M3 - Article

AN - SCOPUS:85064322997

VL - 14

JO - Preventive Medicine Reports

JF - Preventive Medicine Reports

SN - 2211-3355

M1 - 100847

ER -