Gender Differences in Smoking and Smoking Cessation Treatment: An Examination of the Organizational Features Related to Care

Abstract

Objectives Veterans experience a particularly heavy burden with smoking rates higher than the general population, and the smoking prevalence for women Veterans has increased in recent years. We examined differences in smoking prevalence and treatment by gender for Veterans receiving at least some of their care at a VA facility, and examined the degree to which organizational factors may be associated with reductions in gender disparities in smoking cessation treatment. Methods We merged national organizational-level data focused on primary care (sites = 225) and women’s health (sites = 195) with patient-level survey data ( n = 15,033 smokers). Organizational measures focused on smoking cessation-specific structure and processes in primary care and women’s health. Primary outcomes were patient-reported receipt of smoking cessation treatments—advised to quit, medication recommendation, and other treatment recommendation. We used multi-level, random-intercept logistic regression. Results In 2007, 29% of women and 23% of men were smokers. Overall, 83% of smokers reported they had been advised to quit, 62% recommended medications, and 60% recommended other treatments. Women were more likely to report being advised to quit (odds ratio, 1.33; 95% confidence interval, 1.07–1.64) but equally likely as men to have medications or other treatment recommended. Organizational factors did not eliminate the gender differences in being advised to quit. Conclusion Despite having equivalent or higher smoking cessation treatment rates, women Veterans were more likely to smoke than men. With the rapid growth of women entering VA care, the need for effective gender-focused and gender-sensitive smoking cessation care arrangements is critical for the future health of women who have served.