Racial and Ethnic Differences in Delivery of Tobacco-Cessation Services

Abstract

Reducing racial and ethnic disparities in health care is an important national goal. Racial and ethnic differences in the delivery of tobacco-cessation services were examined in the course of visits to primary care physicians. In 2007, data about tobacco screening were analyzed from 29,470 visits by adult patients to 2153 physicians in the 2001-2005 National Ambulatory Medical Care Survey, a cross-sectional survey. Counseling was examined for visits by patients with known current tobacco use. Logistic regression models included age, gender, visit diagnoses, expected payment source, and past-year visits to the provider. The respective percentages of visits with tobacco screening and counseling were 79.2% and 28.8% for non-Hispanic white patients, 79.3% and 29.2% for non-Hispanic black patients, 80.2% and 30.6% for non-Hispanic Asian patients, and 68.2% and 21.4% for Hispanic patients. In multivariable models, the adjusted difference between Hispanics and non-Hispanic whites in the percentage of visits with screening was -7.9 (95% CI=-15.5, -0.3) and of visits with counseling was -7.6 (95% CI=-15.2, 0.0). Tobacco screening and counseling were less common at visits made by Hispanics compared to non-Hispanic whites. Traditional barriers to care among Hispanic patients, such as lack of insurance and more new-patient visits, did not explain the observed differences.