Racial-ethnic Variation in the Use of Pharmacotherapy for Smoking Cessation by Veteran Smokers

Fu SS, Sherman SE, Yano EM, VanRyn M, Lanto AB, Joseph AM. Racial-ethnic Variation in the Use of Pharmacotherapy for Smoking Cessation by Veteran Smokers. Paper presented at: VA HSR&D National Meeting; 2003 Feb 13; Washington, DC.

Related HSR&D Project(s)

• CPG 97-002 – Implementing Guidelines for Smoking Cessation: A Randomized Trial of Evidence-Based Quality Improvement

Objectives: Pharmacotherapy for smoking cessation is a safe and effective intervention that is available to treat tobacco dependence and assist smokers to quit smoking. The objective of this study was to assess whether there is racial/ethnic variation in the use of pharmacotherapy by veteran smokers. Methods: We performed a cross-sectional analysis of current smokers enrolled at baseline in the Quality Improvement Trial for Smoking Cessation (QUITS). The QUITS study is a randomized controlled trial of an organizational support intervention to improve adherence to the AHCPR Smoking Cessation Guideline among 18 Veteran Affairs Medical Centers and Ambulatory Care Centers in the Southwestern US. At baseline, random samples of primary care patients with three or more primary care visits in VA FY '99 at the participating sites were enrolled and surveyed using computer-assisted telephone interviewing (CATI) techniques from March-December, 2000. Results: At baseline, 9924 subjects were enrolled in the study (40% of eligible subjects). 20% of subjects were identified as current smokers (n = 1941). Characteristics of current smokers were as follows: 59% Caucasian men, 16% African American men, 8% Hispanic men, 11% other race/ethnicity men, and 7% women. 87% of current smokers reported they had ever tried to quit smoking, and 77% reported quitting intentionally for one or more days in the past 12 months. Caucasian male smokers were more likely to report having ever used the nicotine patch or gum (49%) during a quit attempt than African American (34%) and Hispanic male smokers (26%) (P < 0.001). In the past 12 months, Caucasian male smokers were more likely to have used the nicotine patch (18%) during a quit attempt than African American (10%) and Hispanic male smokers (13%)(P = 0.014). Only 4% of current smokers used nicotine gum during a quit attempt in the past 12 months and there were no significant differences between racial/ethnic groups. Conclusions: This study indicates that there is racial/ethnic variation in the use of tobacco dependence medications. In particular, African American and Hispanic male veteran smokers were less likely to use tobacco dependence medications as a cessation aid during attempts to quit smoking. Impact: The VA provides coverage for certain tobacco dependence medications. It is important to determine whether race/ethnicity, sociodemographic or other characteristics explain the lower use of tobacco dependence treatment medications among racial/ethnic minority veteran smokers. The VA provides health care to a lower income population with significant dual Medicaid or dual Medicare coverage and these findings may be relevant to non-veteran racial/ethnic minority populations.