Kelly C Young-Wolff1, Andrea H Kline-Simon1, Smita Das1, Don J Mordecai1, Chris Miller-Rosales1, Constance Weisner1. 1. Dr. Young-Wolff, Ms. Kline-Simon, Mr. Miller-Rosales, and Dr. Weisner are with the Division of Research, Kaiser Permanente, Oakland, California (e-mail: kelly.c.young-wolff@kp.org ). Dr. Weisner is also with the Department of Psychiatry, University of California, San Francisco. Dr. Das is with Stanford University Hospitals and Clinics, Palo Alto, California. Dr. Mordecai is with the Permanente Medical Group, Kaiser Permanente Northern California, Santa Clara.
Abstract
OBJECTIVE: Individuals with behavioral health conditions (BHCs) smoke at high rates and have limited success with quitting, despite impressive gains in recent decades in reducing the overall prevalence of smoking in the United States. This study examined smoking disparities among individuals with BHCs within an integrated health care delivery system with convenient access to tobacco treatments. METHODS: The sample consisted of patients in an integrated health care delivery system in 2010-a group (N=155,733) with one or more of the five most prevalent BHCs (depressive disorders, anxiety disorders, substance use disorders, bipolar and related disorders, and attention-deficit hyperactivity disorder) and a group (N=155,733) without BHCs who were matched on age, sex, and medical home facility. The odds of smoking among patients with BHCs versus without BHCs were examined over four years using logistic regression generalized estimating equation models. Tobacco cessation medication utilization among a subset of smokers in 2010 was also examined. RESULTS: Although smoking prevalence decreased from 2010 to 2013 overall, the likelihood of smoking decreased significantly more slowly among patients with BHCs compared with patients without BHCs (p<.001), most notably among patients with substance use and bipolar and related disorders. Tobacco cessation medication use was low, and smokers with BHCs were more likely than smokers without BHCs to utilize these products (6.2% versus 3.6%, p<.001). CONCLUSIONS: Smoking decreased more slowly among individuals with BHCs compared with individuals without BHCs, even within an integrated health care system, highlighting the need to prioritize smoking cessation within specialty behavioral health treatment.
OBJECTIVE: Individuals with behavioral health conditions (BHCs) smoke at high rates and have limited success with quitting, despite impressive gains in recent decades in reducing the overall prevalence of smoking in the United States. This study examined smoking disparities among individuals with BHCs within an integrated health care delivery system with convenient access to tobacco treatments. METHODS: The sample consisted of patients in an integrated health care delivery system in 2010-a group (N=155,733) with one or more of the five most prevalent BHCs (depressive disorders, anxiety disorders, substance use disorders, bipolar and related disorders, and attention-deficit hyperactivity disorder) and a group (N=155,733) without BHCs who were matched on age, sex, and medical home facility. The odds of smoking among patients with BHCs versus without BHCs were examined over four years using logistic regression generalized estimating equation models. Tobacco cessation medication utilization among a subset of smokers in 2010 was also examined. RESULTS: Although smoking prevalence decreased from 2010 to 2013 overall, the likelihood of smoking decreased significantly more slowly among patients with BHCs compared with patients without BHCs (p<.001), most notably among patients with substance use and bipolar and related disorders. Tobacco cessation medication use was low, and smokers with BHCs were more likely than smokers without BHCs to utilize these products (6.2% versus 3.6%, p<.001). CONCLUSIONS: Smoking decreased more slowly among individuals with BHCs compared with individuals without BHCs, even within an integrated health care system, highlighting the need to prioritize smoking cessation within specialty behavioral health treatment.
Authors: Kelly C Young-Wolff; Daniella Klebaner; Cynthia I Campbell; Constance Weisner; Derek D Satre; Alyce S Adams Journal: Med Care Date: 2017-05 Impact factor: 2.983
Authors: Jennifer O Lam; Tory Levine-Hall; Nicole Hood; Stacey E Alexeeff; Michael A Horberg; Kelly C Young-Wolff; Stacy A Sterling; Andrew Williams; Constance Weisner; Derek D Satre; Michael J Silverberg Journal: Drug Alcohol Depend Date: 2020-06-18 Impact factor: 4.852
Authors: Alison R Hwong; Julie Schmittdiel; Dean Schillinger; John W Newcomer; Susan Essock; Zheng Zhu; Wendy Dyer; Kelly C Young-Wolff; Christina Mangurian Journal: Addict Behav Date: 2020-10-14 Impact factor: 3.913