Research

Special Populations

Persons with Chronic Illness Continue to Smoke

A substantial number of smokers who report having a diagnosed chronic condition continue to smoke despite their health problems, according to new data from AHRQ. Specifically, in 2000, about 37.9 percent of people with emphysema, 24.8 percent of people with asthma, 20 percent of people with hypertension or cardiovascular problems, and 18.5 percent of people with diabetes reported that they currently smoked. In addition, three out of five smokers who also had the chronic conditions listed above reported that their doctor had advised them in the previous 12 months to stop smoking. Overall, about 57 percent of smokers who had a routine checkup in the previous 12 months were counseled by a physician to stop smoking. The new data come from a self-administered questionnaire added to AHRQ's Medical Expenditure Panel Survey (MEPS) in late 2000/early 2001 to collect information on health care quality and satisfaction with health care. More than 15,600 people responded to the survey questions.

Agency for Healthcare Research and Quality (AHRQ), Report published 2002

Smoking Cessation with Building Trades Workers

BACKGROUND: Taft Hartley Funds provide group health care coverage for 10 million union workers as well as their dependents in industries such as construction and transportation. The adult smoking rate in these populations is estimated at approximately 40%, therefore, these funds include 9 million adult smokers. A prototype for Taft Hartley Funds consistent with the AHRQ Clinical Guidelines for Smoking Cessation was designed and implemented in a pilot demonstration in the Carpenters Health and Security Trust of Western Washington. Participants chose a 1-call or more intensive 5-call smoking cessation counseling plan provided by the Group Health Cooperative's Free and Clear program. Medications were limited to the nicotine patch, nicotine gum, and Bupropion. Assessment of outcomes was performed through a telephone survey 12 months following the enrollment date.

RESULTS: 935 smokers participated in the program. This pilot evaluation covers 325 participants with at least 12 months since enrollment; 75% were male, the average age was 41.4 and 63% had smoked at least one pack per day for more than 20 years. 61% selected 5-Call Counseling; 39% 1-Call. 75% also used smoking cessation medications: gum, 4%; patch, 32%; Bupropion 21.5%; patch plus Bupropion, 15.7%. The point-prevalence-quit rates were: overall, 27.5%; 1-Call, 25.5%; and 5-Call, 28.9%. The cost of the program was $1025.28 per smoker who quit, or $11.78 per full-time equivalent employee covered by the Fund per year. The compounded savings in reduced lifetime tobacco-related medical costs for the participants who quit are estimated to be 15 times the cost of the program, yielding an annual return on investment of 27.6%. These results strongly suggest that smoking cessation programs can be effective even in such hard-to-reach populations as itinerant building trades workers, provided that the program is designed to their needs and environment. Based on these findings, the authors suggest that health plans need to consider whether they are at risk of violating their fiduciary duties if they fail to offer smoking cessation benefits.

Ringen K, et al. 2002. Smoking cessation in a blue-collar population: Results from an evidence-based pilot program. American Journal of Industrial Medicine 42, 367-77.

Appalachian Tobacco Use

BACKGROUND: Appalachians remain at high risk for cancer, heart and lung disease, in part because of their high prevalence of tobacco use; yet, information about their tobacco consumption patterns is limited. The purpose of this study was to describe tobacco consumption variables among rural adult Appalachian tobacco users.

METHODS: Subjects, aged 18 and older (N=249), participated in a face-to-face interview about tobacco consumption variables and knowledge regarding the health effects of tobacco at fairs in two rural Ohio Appalachian counties.

RESULTS: The majority of participants were categorized as precontemplators, although 21 percent were classified in preparation stage of change. Mean age of initiation was 16.6 years and number of cigarettes smoked per day (cpd) was significantly higher for men, as compared to women. One-third of males reported the use of smokeless tobacco. The majority had not tried to quit for more than a year and average number of previous quit attempts was low. One-half of the sample had been advised in the past to quit by their physician. Few had used nicotine replacement with past quit attempts but greater than half would consider this approach with future attempts. Knowledge about the health effects of smoking indicated that most were aware of the relationship between smoking and cancer but less than one-half recognized its association with heart disease. Those with less education were less informed about the health effects to self and non-smokers. While a sizeable portion expressed interest in quitting, knowledge about the health effects of smoking is lacking, especially with regard to heart disease and among those with less education.

Wewers, ME et al. (2000). Tobacco use characteristics among rural Ohio Appalachians. Journal of Community Health, 25, 377-388.

Exposure to Cigarette Smoke Constituents in African American & White Women

BACKGROUND: Differences in smoke constituent exposure by ethnicity and menthol preference and differences in decisional balance and habit strength by stage of change, ethnicity and menthol preference were examined in a 2-factor study design. 95 women, half of whom were Black and half of who smoked menthol cigarettes, participated by smoking one of their usual cigarettes in a protocol conducted in the General Clinical Research Center. Measures of smoking topography, plasma cotinine and nicotine, and carbon monoxide in exhaled air were obtained in addition to self-report of the pros and cons of smoking, time to first cigarette, and smoking history.

RESULTS: Black women smoked significantly fewer cigarettes per day, but had higher cotinine levels than White women. Menthol smokers (n=49) had significantly larger puff volumes, higher cotinine levels, and shorter time to first cigarette than nonmenthol smokers (n=46). Black women, all stages of change combined, had higher negative beliefs about smoking than did White women.

Ahijevych, K et al. (1999). Smoke constituent exposure and stage of change in black and white women cigarette smokers. Addictive Behaviors, 24:115-120.

Smoking in Adults with Disabilities

BACKGROUND: This study examined the characteristics of smoking among adults with disabilities in Massachusetts.

DESIGN: Data were obtained from the 1996-1999 Massachusetts Behavioral Risk Factor Surveillance System, a random digit dial telephone survey. Respondents reporting use of special equipment or a limitation caused by impairment or health problem were classified as having a disability. Adults with disabilities were further classified by level, based on need for assistance, and type of disability. Logistic regression models were used to assess the association between disability status and smoking.

SETTING AND PARTICIPANTS: Random sample of non-institutionalized Massachusetts’s adults, 18 and older, with disabilities (n=2985) and without disabilities (n=14395). Smoking status, intensity, and factors related to quitting were the main outcome measures.

RESULTS: Compared to those without disabilities, adults with disabilities were more likely to have ever smoked (odds ratio (OR) 1.42) and to be current smokers (OR 1.52). Smoking rates varied by type of disability. Among current smokers, adults with disabilities smoked more cigarettes per day (OR 1.52), sooner after waking, and were more likely to be advised by a doctor to quit. Adults with disabilities who needed assistance were more likely to be planning to quit. There are disparities in smoking rates between adults with and without disabilities. The findings suggest that smoking cessation programs targeted to the disabled community are needed.

Brawarsky P, et al. (2002). Tobacco use among adults with disabilities in Massachusetts. Tobacco Control,11(Suppl 2):II29-II33.