Brief reports
Under-use of smoking-cessation treatments: Results from the National Health Interview Survey, 2000

https://doi.org/10.1016/j.amepre.2004.09.007Get rights and content

Objective

To describe the use of treatment for tobacco dependence in relation to insurance status and advice from a healthcare provider in a population-based national sample interviewed in 2000.

Methods

Analyses are based on 3996 adult smokers who participated in the National Health Interview Survey in 2000, and who provided information on tobacco-cessation treatments used at their most recent quit attempt occurring in the last year. Age-adjusted and weighted categorical analysis was used to compute prevalence estimates of self-reported treatments (pharmacotherapy and behavioral counseling) for tobacco dependence. Multivariate logistic regression analyses were used to examine factors associated with use of treatments.

Results

Overall, 22.4% of smokers who tried to quit in the previous year used one or more types of cessation aid compared to 15% in 1986. Treatment usually involved pharmacotherapy (21.7%) rather than behavioral counseling (1.3%). Smokers attempting to quit were more likely to use cessation aids if covered by private (25.4%) or military (25.0%) insurance than by Medicare (17.8%), Medicaid (15.5%), or no insurance (13.2%). In a multivariate analysis of factors related to use of cessation aids, advice from a healthcare provider to quit smoking and the number of cigarettes smoked per day were significant predictors of treatment use, regardless of insurance status.

Conclusions

Cessation aids are under-used across insurance categories. Advice by a healthcare provider to quit is associated with increased use of effective therapies for tobacco dependence. Systematic efforts are needed to eliminate barriers to appropriate treatment.

Introduction

Despite significant progress in reducing smoking prevalence and per capita cigarette consumption in the United States, the percentage of smokers who succeed in any given quit attempt remains low.1, 2 Treatment using a combination of behavioral counseling and pharmacotherapy can increase long-term cessation rates from ≤11% to between 15% and 25%.3 Current treatment guidelines recommend that every patient who uses tobacco should be counseled by a healthcare provider to quit smoking and should be offered tobacco dependence treatments in the absence of contraindications.3 Despite the demonstrated efficacy and safety of such treatments,4 and their increased availability in the 1990s,2, 5, 6 the prevalence of treatment for tobacco dependence remains low, ranging from 8.5% to 21% in four recent state-based surveys.7, 8, 9, 10, 11

The last national prevalence estimate of the use of cessation aids at the last quit attempt (15%) were based on data collected in 1986.12 This report provides national estimates of treatments for smoking cessation used at the last quit attempt among smokers, using data collected in 2000 in the National Health Interview Survey (NHIS).

Section snippets

Data source

Data were used from the 2000 NHIS, Cancer Control Supplement (CCM), to describe the prevalence of treatment for smoking cessation among smokers who attempted to stop for at least 1 day. The NHIS is a cross-sectional, annual, household interview survey of the civilian noninstitutionalized household population of the United States, conducted by the National Center for Health Statistics. Methodologic details of NHIS 2000 can be found elsewhere.13, 14 A total of 32,374 individuals aged ≥18 were

Results

Overall, only 22.4% of smokers in the survey who tried to quit in the last year had used any type of cessation aids. The use of any cessation aids was low across all categories of health insurance but was lowest for the uninsured (13.2%) and for smokers with Medicaid (15.5%) and Medicare (17.8%) insurance. Use of pharmacotherapy was more common (21.7%) than use of behavioral counseling (1.3%) (Table 1).

Among 3010 current smokers and former smokers who tried to quit and had seen a healthcare

Discussion

This report shows that based on the national 2000 NHIS survey, the reported use of recommended treatments for smoking cessation was low across insurance categories. Less than 18% of smokers with Medicare, Medicaid, or no health insurance, and only 25% of those with private or military insurance used appropriate treatment. The low overall prevalence observed nationally is consistent with previous state-based reports.8, 9, 10, 11 The reported use of cessation aids by smokers trying to quit was

References (28)

  • A clinical practice guideline for treating tobacco use and dependencea U.S. Public Health Service report

    JAMA

    (2000)
  • M. Goldstein et al.

    Physicians counseling smokers. A population-based survey of patients’ perceptions of health care provider-delivered smoking cessation interventions

    Arch Intern Med

    (1997)
  • J. Pierce et al.

    Impact of over-the-counter sales on effectiveness of pharmaceutical aids for smoking cessation

    JAMA

    (2002)
  • A. Thorndike et al.

    Effect on smoking cessation of switching nicotine replacement therapy to over-the-counter status

    Am J Public Health

    (2002)
  • Cited by (0)

    View full text