Health professionals’ advice to quit smoking: Does race and gender of smokers matter?

PR-6

Introduction: African Americans, especially African American men, disproportionately bear greater burden of smoking-related diseases than their White counterparts (USDHHS, 1998). The lower smoking cessation rate among African Americans (CDC, 1998) contributes to disparities in tobacco-related morbidity. Receipt of advice from health professionals to quit smoking plays an important role in smoking cessation (Tong et al., 2006; Williams et al, 2001). African Americans were reported to receive less advice from their health care providers than Whites (CDC, 2000; Franks et al., 2005; Houston et al, 2005). However, it is not clear whether race is an independent factor and how race interacts with other characteristics of smokers, e.g. gender. In this study, we examined an independent effect of race on advice to quit smoking from health professionals and its possible gender variation in a random digit dial survey. Methods: A survey was conducted using Computer-Assisted Telephone Interviewing and random digit dialing procedure in 2001-2003 among adults aged 18 and over who were residents in 13 Maryland jurisdictions. A total of 5154 residents participated, including 1205 current smokers (23.4% of all participants). The analytic sample was restricted to the current smokers who reported themselves as White or African American (n=1169). Advice of health care providers was assessed by a standardized question “Has a doctor, nurse or other health professional ever advised you to quit smoking?” Multivariate logistic regression was conducted with or without adjustment for other confounders, e.g. age, gender, education, insurance status, health condition and the quantity of cigarettes smoked per day. The logistic regression models were further stratified by gender. Results: An estimated 75% of White smokers received advice from their health care providers to quit smoking and 67% African American smokers. Compared to White smokers, African American smokers were less likely to receive advice on quitting smoking (OR=0.68, 95% CI: 0.48, 0.95) even after adjusting for other covariates. Gender-stratified analyses showed that the racial difference was statistically significant for males (OR=0.46, 95% CI: 0.27, 0.76), but not for females (OR=0.94, 95% CI: 0.58, 1.54). Conclusions: Our findings suggest African Americans, especially African American males, are less likely to receive advice to quit smoking than their White counterparts, regardless of their socioeconomic status or health status. Prevention efforts to decrease the smoking-related health disparities among minorities must include effective education and training of health care providers to advise African American smokers to quit smoking. Acknowledgements: Maryland Cigarette Restitution Fund Program, the National Cancer Institute supported Maryland Special Populations Cancer Research Network (grant U01CA86249).