Abstract
Nationally, Latino smokers are less likely than non-Latino White smokers to receive advice and assistance from health professionals to quit smoking. California's Medicaid expansion included the Patient Protection and Affordable Care Act's comprehensive tobacco cessation benefits; however, it is unknown whether expanded coverage helped resolve this disparity. To examine the association between race and ethnicity (Latino and non-Latino White) and health professional cessation advice and assistance among smokers with Medi-Cal insurance in the post-Affordable Care Act period. This repeated cross-sectional study was conducted with the 2014 and 2016-2018 California Health Interview Survey. A total of 1861 Latino and non-Latino White current smokers aged 18 to 64 years who had Medi-Cal insurance and consulted a health professional in the past 12 months were included. Data were analyzed between December 1, 2019, and April 30, 2021. Race and ethnicity classified as Latino or non-Latino White. The outcomes were receipt of health professional advice to quit smoking or assistance to quit in the past 12 months. Logistic regression was used to examine the association between race and ethnicity and each outcome, adjusted for sociodemographic factors, smoking behavior, health care factors, and acculturation measures. All estimates were weighted to adjust for the complex survey design. Among 1861 participants, 44.8% were Latino, 53.8% were aged 40 years or older (mean [SE], 39.7 [0.79] years), 54.1% were male, and 59.9% had less than a high school education. Latino smokers were less likely than non-Latino White smokers to receive health professional advice (38.3% Latino smokers vs 55.3% non-Latino White smokers) or assistance (21.8% Latino smokers vs 35.7% non-Latino White smokers). In the unadjusted model, compared with non-Latino White smokers, Latino smokers were less likely to receive advice (odds ratio [OR], 0.50; 95% CI, 0.29-0.86) and also less likely to receive assistance (OR, 0.50; 95% CI, 0.25-1.00). However, in the adjusted model, race was no longer significant. Smokers with more office visits (adjusted OR, 2.44; 95% CI, 1.61-3.70) and those with at least 1 chronic disease (adjusted OR, 1.99; 95% CI, 1.15-3.43) were more likely to receive advice from a health professional. Additionally, daily smokers compared with nondaily smokers (adjusted OR, 2.29; 95% CI, 1.03-5.13) were more likely to receive assistance. In this cross-sectional study, more office visits, having a chronic disease, and daily smoking were associated with an increased likelihood of receiving smoking cessation advice or assistance. Use of strategies to engage tobacco users outside of the clinic, such as proactive outreach and community-based engagement, may help address this disparity.
Highlights
Tobacco use is still a major cause of morbidity and mortality in the United States.[1]
Latino smokers were less likely than non-Latino White smokers to receive health professional advice (38.3% Latino smokers vs 55.3% non-Latino White smokers) or assistance (21.8% Latino smokers vs 35.7% non-Latino White smokers)
Smokers with more office visits and those with at least 1 chronic disease were more likely to receive advice from a health professional
Summary
Tobacco use is still a major cause of morbidity and mortality in the United States.[1]. Access to health insurance coverage and health care services, including tobacco cessation treatment, is a known barrier among Latino individuals,[5] but through the Patient Protection and Affordable Care Act (ACA), many of them gained health care access. Few studies have examined whether tobacco treatment disparities persist in the post-ACA era, or between Latino and non-Latino White smokers. Pre–Affordable Care Act studies reported that Latino smokers were less likely than non-Latino White smokers to receive advice to quit and cessation assistance from a health professional[6,7,8,9]; these studies examined racial and ethnic differences across the overall population. Spanish-speaking daily smokers reported lower rates of advice from a health professional to quit (70%) compared with English-speaking daily smokers (84%). The study findings highlight the importance of assessing language and smoking intensity among Latino populations to provide comprehensive services
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