Under-use of smoking-cessation treatments: results from the National Health Interview Survey, 2000.

OBJECTIVE: To describe the use of treatment for tobacco dependence in relation to insurance status and advice from a healthcare provider in a population-based national sample interviewed in 2000.
METHODS: Analyses are based on 3996 adult smokers who participated in the National Health Interview Survey in 2000, and who provided information on tobacco-cessation treatments used at their most recent quit attempt occurring in the last year. Age-adjusted and weighted categorical analysis was used to compute prevalence estimates of self-reported treatments (pharmacotherapy and behavioral counseling) for tobacco dependence. Multivariate logistic regression analyses were used to examine factors associated with use of treatments.
RESULTS: Overall, 22.4% of smokers who tried to quit in the previous year used one or more types of cessation aid compared to 15% in 1986. Treatment usually involved pharmacotherapy (21.7%) rather than behavioral counseling (1.3%). Smokers attempting to quit were more likely to use cessation aids if covered by private (25.4%) or military (25.0%) insurance than by Medicare (17.8%), Medicaid (15.5%), or no insurance (13.2%). In a multivariate analysis of factors related to use of cessation aids, advice from a healthcare provider to quit smoking and the number of cigarettes smoked per day were significant predictors of treatment use, regardless of insurance status.
CONCLUSIONS: Cessation aids are under-used across insurance categories. Advice by a healthcare provider to quit is associated with increased use of effective therapies for tobacco dependence. Systematic efforts are needed to eliminate barriers to appropriate treatment.