Results
Screening
From 2005 through 2010, adults aged 18 years or older made, on average, 71.8 million hospital outpatient visits annually to hospital outpatient physicians (range, 62.9 million in 2005 to 80.3 million in 2008), or an estimated 431 million visits from 2005 through 2010 combined. On average, 45.2 million (63.0%) hospital outpatient visits included tobacco use screening each year, or an estimated 271 million visits from 2005 through 2010 combined (Table). Of the visits that included tobacco use screening, 25.7% (11.6 million annual average visits) were made by current tobacco users. From 2005 through 2010, tobacco use screening did not change over time after adjusting for sex, age, and race/ethnicity (P for trend = .06) (Figure 1).
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Figure 1.
Percentage of tobacco use screening during hospital outpatient visits by adults aged 18 years or older, National Hospital Ambulatory Medical Care Survey, United States 2005–2010.
Tobacco use screening during hospital outpatient visits varied by patient's race/ethnicity; visits made by Hispanics (55.4%) were less likely to receive tobacco use screening than those by non-Hispanic whites (65.1%). Patients who visited their primary care physician or provider were more likely to receive tobacco use screening (71.6%) than those who visited a physician who was not their primary care physician or provider (58.5%). Patients who made visits for a chronic problem (routine or flare-up) were less likely to receive tobacco use screening (59.9%) than those who visited with a new problem (<3 months onset) (67.9%). Patients who made visits to general medicine clinics (67.1%) were more likely to receive tobacco use screening than those who made visits to surgical clinics (55.7%) or clinics with other specialties (45.2%), excluding obstetrics and gynecology (62.8%) and substance abuse clinics (68.3%). Screening for tobacco use did not vary by poverty level.
Current Tobacco Use
The proportion of visits made by adults who screened positive for current tobacco use varied by patient's age, sex, and race/ethnicity. Current tobacco use was greater among those younger than 65 years (18–24 y, 26.5%; 25–44 y, 30.9%; 45–64 y, 29.5%) than those aged 65 years or older (11.7%), among men (31.1%) than women (22.8%), and among non-Hispanic whites (26.1%) and non-Hispanic blacks (29.1%) than Hispanics (20.2%). Patients who screened positive for current tobacco use also varied by health insurance type. Current tobacco use was greater among those with Medicaid or SCHIP benefits (35.5%) or no insurance (34.9%) than those with private insurance (21.1%) or Medicare (18.0%). Current tobacco use was higher among patients living in a high poverty zone (zip code with 5.00%–9.99% poverty, 24.1%; zip code with 10.00%–19.99% poverty, 26.2%; and zip code with ≥20.00% poverty, 28.8%) than those living in a low poverty zone (zip code with <5.00% poverty, 19.2%). Lower prevalence of tobacco use was observed among patients who made visits for preventive care (18.7%) than those who made visits for a new problem (28.4%), chronic problem (26.8%), presurgery/postsurgery (23.3%), or overall nonpreventive care (27.3%). Higher prevalence of tobacco use was also observed among those visiting substance abuse clinics (72.3%) than among those visiting all other types of clinics, including general medicine (26.4%), surgery (23.0%), obstetrics and gynecology (18.7%), and other clinics (29.2%). Current tobacco use decreased from 28.9% in 2005 to 22.6% in 2010 among hospital outpatient visits (P for trend <.001).
Cessation Assistance
Among patients who screened positive for current tobacco use, 24.5% (or an estimated 17.1 million visits) received any cessation assistance, including tobacco counseling, a prescription or order for a cessation medication at the visit, or both. Cessation assistance was higher for visits made by those with Medicaid/SCHIP (27.6%) than those with private insurance (21.8%) or Medicare (21.4%). Patients living in a high poverty zone were more likely to receive cessation assistance (zip code with 5.00%–9.99% poverty, 23.4% of visits; zip code with 10.00%–19.99% poverty, 23.8% of visits; and zip code with ≥20.00% poverty: 29.1% of visits) than those living in a low poverty zone (zip code with <5.00% poverty, 15.7% of visits). Receipt of cessation assistance was higher among those who visited their primary care physician (29.2% of visits) than those who visited a physician who was not their primary care physician (20.6% of visits). By major reason for the visit, cessation assistance was higher for preventive care (30.5% of visits) and chronic problems (26.8% of visits) than those for new problems (20.7% of visits), presurgery or postsurgery (17.5% of visits), and overall nonpreventive care (23.6% of visits). Higher prevalence of assistance was observed among patients who made a visit to general medicine clinics (26.7% of visits) than those made to surgical clinics (12.7% of visits). From 2005 through 2010, cessation assistance did not change over time after adjusting for sex, age, and race/ethnicity (P for trend = .17) (Figure 2).
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Figure 2.
Percentage of cessation assistance (counseling, or medications, or both) ordered or provided during hospital outpatient visits by adults aged ≥18 years, National Hospital Ambulatory Medical Care Survey, United States 2005–2010.