Variations in Cigarette Smoking and Quit Attempts by Health Insurance Among US Adults in 41 States and 2 Jurisdictions, 2014

Prevalence of Current Cigarette Smoking by Sociodemographic Characteristics in U.S. Cancer Survivors

BACKGROUND

Cancer survivors are especially vulnerable to the carcinogenic effects of tobacco smoking, but there lacks a study comprehensively examining the sociodemographic disparities in current smoking prevalence in this population. In this study, we quantified the current cigarette smoking prevalence in cancer survivors and those without cancer history by sociodemographic factors, to identify subpopulations with high current smoking burden.

METHODS

We conducted a cross-sectional study of 3,679 cancer survivors and 27,350 participants without cancer history who were 18 years of age or above in the 2019 National Health Interview Survey. Data for the study variables were obtained from computer-assisted personal or telephone interviews. Weighted Poisson regression was used to estimate prevalence ratios and 95% confidence intervals.

RESULTS

Although the current smoking prevalence for cancer survivors was slightly lower than for those without cancer history, the prevalence exceeded 30% in cancer survivors in poverty or without health insurance. Individuals with significantly higher current smoking prevalence had lower education levels, were unmarried, did not have health insurance, or lived in poverty. The associations of age, sex, race, health insurance status, and poverty status with current smoking significantly differed between cancer survivors and those without cancer history. Sociodemographic disparities in current smoking prevalence were found in survivors of either smoking-related or nonsmoking-related cancers.

CONCLUSION

High current smoking prevalence still exists in subpopulations of cancer survivors and those without cancer history. Our findings may strengthen efforts to reduce sociodemographic disparities in current smoking prevalence and to lower the overall smoking prevalence.

Association between maternal e-cigarette use during pregnancy and low gestational weight gain

OBJECTIVE

To evaluate the risk of low gestational weight gain (GWG) in women who use electronic cigarettes (e-cigarettes), combustible cigarettes, or both e-cigarettes and combustible cigarettes (dual use) during pregnancy.

METHODS

We conducted a secondary analysis of the data from 176 882 singleton pregnancies in the 2016-2020 US Pregnancy Risk Assessment Monitoring System (PRAMS). Postpartum women self-reported their use of e-cigarettes and/or cigarettes during the last 3 months of pregnancy. Low GWG was defined as the total GWG less than 12.7 kg, less than 11.3 kg, less than 6.8 kg, and less than 5.0 kg (<28, <25, <15, and < 11 lb) for women with underweight, normal weight, overweight, and obesity, respectively. We used multivariable logistic regression to estimate the odds ratios (ORs) of low GWG, adjusting for confounders.

RESULTS

In this national sample, 921 (weighted percentage, 0.5%) of women were e-cigarette users and 1308 (0.7%) were dual users during late pregnancy. Compared with non-users during late pregnancy (40 090, 22.1%), cigarette users (4499, 28.0%) and dual users (427, 26.0%) had a higher risk of low GWG, but e-cigarette users had a similar risk (237, 22.1%). Adjustment for sociodemographic and pregnancy confounders moderately attenuated these associations: confounder-adjusted ORs 1.26 (95% confidence interval [CI] 1.18-1.35) for cigarette users, 1.18 (95% CI 0.96-1.44) for dual users, and 0.99 (95% CI 0.78-1.27) for e-cigarette users.

CONCLUSIONS

Unlike combustible cigarette use, e-cigarette use during late pregnancy does not appear to be a risk factor for low GWG.

Current state of unhealthy living characteristics in Black/African American and Latino populations: Tobacco use

Over the past six decades, the United States has significantly improved tobacco-related health outcomes through mass efforts in policies, research, and behavioral and clinical interventions. Disparities persist, however, among communities of color who continue to suffer disproportionate rates of cardiovascular disease and other tobacco-related morbidity and mortality. In this review, we synthesize and discuss the tobacco use lifecycle across the lifespan, with special attention paid to socioecological determinants of tobacco-use behavior among Blacks and Latinos. This review summarizes the permeability of tobacco use and tobacco-related determinants across multiple levels of influence, from the individual to the societal, and highlights gaps in the tobacco control and prevention landscape. Given its continued evolution and impact on socially disadvantaged communities, we conclude with recommendations for improving current tobacco research and treatment and prevention efforts.

Online Versus Telephone Registration: Differences in Quitline Participant Characteristics

INTRODUCTION

Although 72% of Internet users have searched for health information, online quitline registration is not universally available. In 2014, QUITPLAN Services (Minnesota's quitline) added options (Individual Services: 2-week nicotine-replacement therapy starter kit, text messaging, e-mail messaging, quit guide) to the existing Helpline (telephone counseling, nicotine-replacement therapy, integrated e-mails and texts, quit guide) and online registration for all programs. Demographic and quit outcome differences by registration mode (online versus telephone) and program type (Individual Services versus Helpline) were examined.

METHODS

A total of 4 years (March 2014-February 2018) of participants' registration and utilization data (N=55,817) were examined. Data were also studied from subsets of participants who completed the outcome evaluations conducted in 2014 (n=1,127) and 2017 (n=872). Select demographic and program use characteristics and quit outcomes were analyzed by registration method and stratified by program type. Associations between registration mode and quit outcomes were examined within program and adjusted for available covariates using 2017 outcome study data. Data were analyzed in 2019.

RESULTS

Overall, 65.8% of participants enrolled online, and 34.2% enrolled by telephone. Helpline participants were more likely to enroll by telephone than Individual Services participants (85.8% vs 25.3%). Younger adults were more likely to enroll online for either program type than older adults (p<0.001). No differences were found in 30-day point prevalence abstinence by registration mode within program after adjusting for covariates.

CONCLUSIONS

Online quitline registration has multiple benefits, including engaging younger tobacco users. Moreover, abstinence rates do not differ. Online registration may be particularly appropriate for nontelephone quitline services. Quitlines may wish to add online registration to capitalize on Internet use.

History and Correlates of Smoking Cessation Behaviors Among Smokers With Serious Mental Illness

INTRODUCTION

Individuals with serious mental illness (SMI) smoke at rates two to three times greater than the general population but are less likely to receive treatment. Increasing our understanding of correlates of smoking cessation behaviors in this group can guide intervention development.

AIMS AND METHODS

Baseline data from an ongoing trial involving smokers with SMI (N = 482) were used to describe smoking cessation behaviors (ie, quit attempts, quit motivation, and smoking cessation treatment) and correlates of these behaviors (ie, demographics, attitudinal and systems-related variables).

RESULTS

Forty-three percent of the sample did not report making a quit attempt in the last year, but 44% reported making one to six quit attempts; 43% and 20%, respectively, reported wanting to quit within the next 6 months or the next 30 days. Sixty-one percent used a smoking cessation medication during their quit attempt, while 13% utilized counseling. More quit attempts were associated with lower nicotine dependence and carbon monoxide and greater beliefs about the harms of smoking. Greater quit motivation was associated with lower carbon monoxide, minority race, benefits of cessation counseling, and importance of counseling within the clinic. A greater likelihood of using smoking cessation medications was associated with being female, smoking more cigarettes, and receiving smoking cessation advice. A greater likelihood of using smoking cessation counseling was associated with being male, greater academic achievement, and receiving smoking cessation advice.

CONCLUSIONS

Many smokers with SMI are engaged in efforts to quit smoking. Measures of smoking cessation behavior are associated with tobacco use indicators, beliefs about smoking, race and gender, and receiving cessation advice.

IMPLICATIONS

Consideration of factors related to cessation behaviors among smokers with SMI continues to be warranted, due to their high smoking rates compared to the general population. Increasing our understanding of these predictive characteristics can help promote higher engagement in evidence-based smoking cessation treatments among this subpopulation.

Cessation Behaviors and Treatment Use Among U.S. Smokers by Insurance Status, 2000-2015

INTRODUCTION

Variations exist in insurance coverage of smoking-cessation treatments and cigarette smokers' use of these treatments. Recent trends in cessation behaviors by health insurance status have not been reported. This study examines trends in quit attempts, provider advice to quit, and use of cessation counseling and/or medications among adult cigarette smokers by insurance status. Demographic correlates of these cessation behaviors are also identified.

METHODS

Data from the 2000-2015 National Health Interview Surveys were used to estimate the prevalence of and trends in past-year quit attempts, receipt of health professional advice to quit, and use of counseling and/or medication among cigarette smokers aged 18-64 years by insurance status (private, Medicaid, or uninsured). Multivariable logistic regression models were used to identify demographic correlates. The analysis was conducted in 2017.

RESULTS

Past-year quit attempts increased linearly among all insurance groups (p<0.05), whereas provider advice to quit remained unchanged. Use of cessation treatment increased linearly among smokers with Medicaid (18.1% [95% CI=13.4%, 22.8%] in 2000 to 34.9% [95% CI=28.5%, 40.5%] in 2015, p<0.05), whereas nonlinear increases were observed among those with private insurance (26.2% [95% CI=24.0%, 28.4%] in 2000 to 32.3% [95% CI=29.0%, 35.6%] in 2015; quadratic trend, p<0.05) and uninsured smokers (13.9% [95% CI=11.0%, 16.8%] in 2000 to 21.8% [95% CI=17.1%, 26.5%] in 2015; quadratic trend, p<0.05). Regardless of insurance status, adults aged 18-24 years had lower odds than older adults of receiving advice to quit and using cessation treatments.

CONCLUSIONS

Despite increased use of cessation treatments among Medicaid enrollees, disparities by insurance status persist in adult cessation behaviors. Opportunities exist to increase cessation by making comprehensive, barrier-free cessation coverage available to all smokers.

Current smoking and quit-attempts among US adults following Medicaid expansion

The objective of this study was to estimate the influence of the Affordable Care Act (ACA) Medicaid Expansion on current smoking and quit attempts in expanded and non-expanded states. We analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) between 2003 through 2015 to evaluate changes in current smoking and quit attempts using multivariable logistic regression and generalized estimating equations (GEE), adjusting for socioeconomic factors. Time periods evaluated were: 2003–2009 (pre-expansion) and 2011–2015 (post-expansion), and in supplemental analysis, also 2011–2017. Overall, smoking prevalence among adults in expanded and non-expanded states were 16% and 17% (p < 0.001), respectively, and quit attempt prevalence for expanded and non-expanded states were 56% and 57% (p = 0.05), respectively. In adjusted models comparing post- versus pre- expansion periods, current smoking declined by 6% in both expanded (RR: 0.94, 95% CI: 0.93–0.94) and non-expanded (RR: 0.94, 95% CI: 0.94–0.95) states. Quit attempts increased by 4% (RR: 1.04, 95% CI: 1.04–1.05) in expanded states, and by 3% (RR: 1.03, 95% CI: 1.02–1.03) in non-expanded states. States that imposed barriers to utilization of smoking cessation services e.g. prior authorization, saw only a 3% increase in quit attempts regardless of expansion status, while expanded states that did not impose barriers experienced a 6% (RR: 1.06, 95% CI: 1.05–1.06) increase in quit attempts. Reducing administrative barriers to smoking cessation programs may enhance further declines in smoking rates among US adults.

Association of Medicaid Expansion and Health Insurance with Receipt of Smoking Cessation Services and Smoking Behaviors in Substance Use Disorder Treatment

This study examined whether living in a Medicaid-expanded state or having health insurance was associated with receipt of smoking cessation services or smoking behaviors among substance use disorder (SUD) treatment clients. In 2015 and 2016, 1702 SUD clients in 14 states were surveyed for health insurance status, smoking cessation services received in their treatment program, and smoking behaviors. Services and behaviors were then compared by state Medicaid expansion and health insurance status independently. Clients in Medicaid-expanded states were more likely to be insured (89.9% vs. 54.4%, p < 0.001) and to have quit smoking during treatment (AOR = 3.77, 95% CI = 2.47, 5.76). Insured clients had higher odds of being screened for smoking status in their treatment program and making quit attempts in the past year. Medicaid expansion supports greater health insurance coverage of individuals in SUD treatment and may enhance smoking cessation.

State-Specific Prevalence of Quit Attempts Among Adult Cigarette Smokers - United States, 2011-2017

From 1965 to 2017, the prevalence of cigarette smoking among U.S. adults aged ≥18 years decreased from 42.4% to 14.0%, in part because of increases in smoking cessation (1,2). Increasing smoking cessation can reduce smoking-related disease, death, and health care expenditures (3). Increases in cessation are driven in large part by increases in quit attempts (4). Healthy People 2020 objective 4.1 calls for increasing the proportion of U.S. adult cigarette smokers who made a past-year quit attempt to ≥80% (5). To assess state-specific trends in the prevalence of past-year quit attempts among adult cigarette smokers, CDC analyzed data from the 2011-2017 Behavioral Risk Factor Surveillance System (BRFSS) surveys for all 50 states, the District of Columbia (DC), Guam, and Puerto Rico. During 2011-2017, quit attempt prevalence increased in four states (Kansas, Louisiana, Virginia, and West Virginia), declined in two states (New York and Tennessee), and did not significantly change in the remaining 44 states, DC, and two territories. In 2017, the prevalence of past-year quit attempts ranged from 58.6% in Wisconsin to 72.3% in Guam, with a median of 65.4%. In 2017, older smokers were less likely than younger smokers to make a quit attempt in most states. Implementation of comprehensive state tobacco control programs and evidence-based tobacco control interventions, including barrier-free access to cessation treatments, can increase the number of smokers who make quit attempts and succeed in quitting (2,3).