State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments - United States, 2018-2022.

The prevalence of cigarette smoking among U.S. adults enrolled in Medicaid is higher than among adults with private insurance; more than one in five adults enrolled in Medicaid smokes cigarettes. Smoking cessation reduces the risk for smoking-related disease and death. Effective treatments for smoking cessation are available, and comprehensive, barrier-free insurance coverage of these treatments can increase cessation. However, Medicaid treatment coverage and treatment access barriers vary by state. The American Lung Association collected and analyzed state-level information regarding coverage for nine tobacco cessation treatments and seven access barriers for standard Medicaid enrollees. As of December 31, 2022, a total of 20 state Medicaid programs provided comprehensive coverage (all nine treatments), an increase from 15 as of December 31, 2018. Only three states had zero access barriers, an increase from two; all three also had comprehensive coverage. Although states continue to improve smoking cessation treatment coverage and decrease access barriers for standard Medicaid enrollees, coverage gaps and access barriers remain in many states. State Medicaid programs can improve the health of enrollees who smoke and potentially reduce health care expenditures by providing barrier-free coverage of all evidence-based cessation treatments and by promoting this coverage to enrollees and providers.

Availability and content of clinical guidance for tobacco use and dependence treatment - United States, 2000-2019.

Evidence-based treatments for tobacco use and dependence can increase cessation success but remain underutilized. Health professional societies and voluntary health organizations (advising organizations) are uniquely positioned to influence the delivery of cessation treatments by providing clinical guidance for healthcare providers. This study aimed to review the guidance produced by these organizations for content and consistency with current evidence. Documents discussing healthcare providers' role in treatment of tobacco use and dependence produced by US-based advising organizations between 2000 and 2019 were identified in both peer-reviewed and grey (i.e., informally or non-commercially published) literature. Extraction of variables, defined in terms of healthcare provider role and endorsement of specific treatment(s), was completed by two independent reviewers. Review of 38 identified documents sponsored by 57 unique advising organizations revealed deficits in the direction of comprehensive care and incorporation of the most recent evidence for treatment of tobacco use and dependence. Documents endorsed: screening (74%), pharmacotherapy (68%), counseling (89%), or follow-up (37%). Few documents endorsed more recent evidence-based treatments including combination nicotine replacement therapy (18%), and text- (11%) and web-based (11%) interventions. Advising organizations have opportunities to address identified gaps and enhance clinical guidance to contribute toward expanding the provision of comprehensive tobacco cessation support.

Screening for Lung Cancer - 10 States, 2017.

Lung cancer is the leading cause of cancer death in the United States; 148,869 lung cancer-associated deaths occurred in 2016 (1). Mortality might be reduced by identifying lung cancer at an early stage when treatment can be more effective (2). In 2013, the U.S. Preventive Services Task Force (USPSTF) recommended annual screening for lung cancer with low-dose computed tomography (CT) for adults aged 55-80 years who have a 30 pack-year* smoking history and currently smoke or have quit within the past 15 years (2).† This was a Grade B recommendation, which required health insurance plans to cover lung cancer screening as a preventive service.§ To assess the prevalence of lung cancer screening by state, CDC used Behavioral Risk Factor Surveillance System (BRFSS) data¶ collected in 2017 by 10 states.** Overall, 12.7% adults aged 55-80 years met the USPSTF criteria for lung cancer screening. Among those meeting USPSTF criteria, 12.5% reported they had received a CT scan to check for lung cancer in the last 12 months. Efforts to educate health care providers and provide decision support tools might increase recommended lung cancer screening.

Disparities in Cessation Behaviors Between Hispanic and Non-Hispanic White Adult Cigarette Smokers in the United States, 2000-2015.

INTRODUCTION: Hispanic adults make up a growing share of US adult smokers, and smoking is a major preventable cause of disease and death among Hispanic adults. No previous study has compared trends in smoking cessation behaviors among Hispanic adults and non-Hispanic white adults over time. We examined trends in cessation behaviors among Hispanic and non-Hispanic white adult cigarette smokers during 2000-2015. METHODS: Using self-reported data from the National Health Interview Survey, we compared trends in quit attempts, receipt of advice to quit from a health professional, and use of cessation treatment (counseling and/or medication) among Hispanic and non-Hispanic white adult smokers. We also assessed these behaviors among 4 Hispanic subgroups. We conducted analyses in 2018-2019. RESULTS: Past-year quit attempts increased during 2000-2015 among both non-Hispanic white and Hispanic smokers, with no significant differences between these groups. Receiving advice to quit increased significantly among non-Hispanic white adults but did not increase significantly among Hispanic adults. Cessation treatment use increased among both non-Hispanic white and Hispanic adults. Throughout 2000-2015, the prevalence of receiving advice to quit and using cessation treatments was lower among Hispanic adults than non-Hispanic white adults. In 2015, a higher proportion of Hispanic than non-Hispanic white smokers visited a health care provider without receiving advice to quit. CONCLUSION: Hispanic adult smokers are less likely to receive advice to quit and to use proven cessation treatments than non-Hispanic white smokers, and this pattern persisted over time. Culturally competent educational initiatives directed at both providers and Hispanic communities could help eliminate this marked and persistent disparity.

Chronic Obstructive Pulmonary Disease and Smoking Status - United States, 2017.

Cigarette smoking is the leading cause of chronic obstructive pulmonary disease (COPD) in the United States; however, an estimated one fourth of adults with COPD have never smoked (1). CDC analyzed state-specific Behavioral Risk Factor Surveillance System (BRFSS) data from 2017, which indicated that, overall among U.S. adults, 6.2% (age-adjusted) reported having been told by a health care professional that they had COPD. The age-adjusted prevalence of COPD was 15.2% among current cigarette smokers, 7.6% among former smokers, and 2.8% among adults who had never smoked. Higher prevalences of COPD were observed in southeastern and Appalachian states, regardless of smoking status of respondents. Whereas the strong positive correlation between state prevalence of COPD and state prevalence of current smoking was expected among current and former smokers, a similar relationship among adults who had never smoked suggests secondhand smoke exposure as a potential risk factor for COPD. Continued promotion of smoke-free environments might reduce COPD among both those who smoke and those who do not.

Severe Pulmonary Disease Associated with Electronic-Cigarette-Product Use - Interim Guidance.

On September 6, 2019, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). As of August 27, 2019, 215 possible cases of severe pulmonary disease associated with the use of electronic cigarette (e-cigarette) products (e.g., devices, liquids, refill pods, and cartridges) had been reported to CDC by 25 state health departments. E-cigarettes are devices that produce an aerosol by heating a liquid containing various chemicals, including nicotine, flavorings, and other additives (e.g., propellants, solvents, and oils). Users inhale the aerosol, including any additives, into their lungs. Aerosols produced by e-cigarettes can contain harmful or potentially harmful substances, including heavy metals such as lead, volatile organic compounds, ultrafine particles, cancer-causing chemicals, or other agents such as chemicals used for cleaning the device (1). E-cigarettes also can be used to deliver tetrahydrocannabinol (THC), the principal psychoactive component of cannabis, or other drugs; for example, "dabbing" involves superheating substances that contain high concentrations of THC and other plant compounds (e.g., cannabidiol) with the intent of inhaling the aerosol. E-cigarette users could potentially add other substances to the devices. This report summarizes available information and provides interim case definitions and guidance for reporting possible cases of severe pulmonary disease. The guidance in this report reflects data available as of September 6, 2019; guidance will be updated as additional information becomes available.

Tobacco Cessation Interventions and Smoke-Free Policies in Mental Health and Substance Abuse Treatment Facilities - United States, 2016.

Persons with mental or substance use disorders or both are more than twice as likely to smoke cigarettes as persons without such disorders and are more likely to die from smoking-related illness than from their behavioral health conditions (1,2). However, many persons with behavioral health conditions want to and are able to quit smoking, although they might require more intensive treatment (2,3). Smoking cessation reduces smoking-related disease risk and could improve mental health and drug and alcohol recovery outcomes (1,3,4). To assess tobacco-related policies and practices in mental health and substance abuse treatment facilities (i.e., behavioral health treatment facilities) in the United States (including Puerto Rico), CDC and the Substance Abuse and Mental Health Services Administration (SAMHSA) analyzed data from the 2016 National Mental Health Services Survey (N-MHSS) and the 2016 National Survey of Substance Abuse Treatment Services (N-SSATS). In 2016, among mental health treatment facilities, 48.9% reported screening patients for tobacco use, 37.6% offered tobacco cessation counseling, 25.2% offered nicotine replacement therapy (NRT), 21.5% offered non-nicotine tobacco cessation medications, and 48.6% prohibited smoking in all indoor and outdoor locations (i.e., smoke-free campus). In 2016, among substance abuse treatment facilities, 64.0% reported screening patients for tobacco use, 47.4% offered tobacco cessation counseling, 26.2% offered NRT, 20.3% offered non-nicotine tobacco cessation medications, and 34.5% had smoke-free campuses. Full integration of tobacco cessation interventions into behavioral health treatment, coupled with implementation of tobacco-free campus policies in behavioral health treatment settings, could decrease tobacco use and tobacco-related disease and could improve behavioral health outcomes among persons with mental and substance use disorders (1-4).

Availability and Promotion of Healthful Foods in Stores and Restaurants - Guam, 2015.

Chronic disease, which is linked to unhealthy nutrition environments, is highly prevalent in Guam. The nutrition environment was assessed in 114 stores and 63 restaurants in Guam. Stores had limited availability of some healthier foods such as lean ground meat (7.5%) and 100% whole-wheat bread (11.4%), while fruits (81.0%) and vegetables (94.8%) were more commonly available; 43.7% of restaurants offered a healthy entrée or main dish salad, 4.1% provided calorie information, and 15.7% denoted healthier choices on menus. Improving the nutrition environment could help customers make healthier choices.

Sodium in Store and Restaurant Food Environments - Guam, 2015.

Compared with the United States overall, Guam has higher mortality rates from cardiovascular disease and stroke (1). Excess sodium intake can increase blood pressure and risk for cardiovascular disease (2,3). To determine the availability and promotion of lower-sodium options in the nutrition environment, the Guam Department of Public Health and Social Services (DPHSS) conducted an assessment in September 2015 using previously validated tools adapted to include sodium measures. Stores (N = 114) and restaurants (N = 63) were randomly sampled by region (north, central, and south). Data from 100 stores and 62 restaurants were analyzed and weighted to account for the sampling design. Across the nine product types assessed, lower-sodium products were offered less frequently than regular-sodium products (p<0.001) with <50% of stores offering lower-sodium canned vegetables, tuna, salad dressing, soy sauce, and hot dogs. Lower-sodium products were also less frequently offered in small stores than large (two or more cash registers) stores. Reduced-sodium soy sauce cost more than regular soy sauce (p<0.001) in stores offering both options in the same size bottle. Few restaurants engaged in promotion practices such as posting sodium information (3%) or identifying lower-sodium entrées (1%). Improving the availability and promotion of lower-sodium foods in stores and restaurants could help support healthier eating in Guam.

Healthcare Providers' Knowledge of Evidence-Based Treatment for Tobacco Dependence, DocStyles 2020.

PURPOSE: Although smoking cessation reduces the risk of all-cause mortality, evidence-based cessation treatments are underused. This study examined healthcare provider knowledge of evidence-based cessation treatments and associations between knowledge and clinical practice characteristics. DESIGN: Cross-sectional survey. SETTING: 2020 DocStyles. SUBJECTS: 1480 U.S. healthcare providers. MEASURES: Provider knowledge of availability of tobacco use disorder diagnostic criteria, clinical practice guideline availability, treatment efficacy, evidence-based counseling modalities, and medications approved by the U.S. Food and Drug Administration (FDA). ANALYSIS: Adjusted odds ratios (aORs), adjusted for personal and clinical practice characteristics. RESULTS: Less than half of respondents demonstrated high knowledge of availability of diagnostic criteria (36.8%), cessation treatment efficacy (33.2%), evidence-based counseling modalities (5.6%), and FDA-approved medications (40.1%). Significant differences were found between specialties: compared to internists, family physicians were less likely to have low knowledge of medications (aOR = .69, 95% CI = .53, .90) and obstetricians/gynecologists were more likely to have low knowledge of medications (aOR = 2.62, 95% CI = 1.82, 3.76). Overall, few associations between knowledge and clinical practice characteristics were identified. CONCLUSION: Most providers had low knowledge of the topics of interest, with little variation across clinical practice characteristics, indicating room for improvement. Efforts to improve provider knowledge of evidence-based treatments are an important component of a comprehensive approach to improving delivery and use of cessation interventions and increasing tobacco cessation.

Employment Characteristics and Tobacco Product Use, U.S., 2021.

INTRODUCTION: Over 30 million U.S. working adults use tobacco, and tobacco use varies by occupation. Limited information is available on employment characteristics and tobacco use prevalence. The purpose of this study was to describe the prevalence of current tobacco use by employment characteristics and occupation group among U.S. working adults. METHODS: This cross-sectional study used 2021 National Health Interview Survey data for currently working adults (n=16,461) analyzed in 2023. Multivariable logistic regression was used to estimate adjusted odds of tobacco use by employment characteristics and occupation group. RESULTS: In 2021, 20.0% of working adults used tobacco. Any tobacco use was significantly lower among workers who were offered workplace health insurance (AOR=0.86, 95% CI=0.77-0.97), had paid sick leave (AOR=0.81, 95% CI=0.73-0.91), and government versus private employment (AOR=0.61, 95% CI=0.52-0.70). Any tobacco use was significantly higher among workers who usually worked ≥35 hours per week versus did not usually work ≥35 hours per week (AOR=1.21, 95% CI=1.06-1.39), worked a rotating or "some other" shift versus daytime shift (AOR=1.19, 95% CI=1.02-1.38), experienced schedule instability (AOR=1.17, 95% CI=1.03-1.31), and worked while physically ill in the past 3 months (AOR=1.25, 95% CI=1.11-1.41). Tobacco use by employment characteristics also varied by occupation group. CONCLUSIONS: Current tobacco use varied according to employment characteristics and occupation group. Findings from this study could inform workplace tobacco cessation interventions and policies (e.g., access to paid sick leave or insurance coverage) to better support tobacco cessation and overall worker health.

Tobacco Cessation Behaviors Among U.S. Middle and High School Students, 2020.

PURPOSE: The landscape of youth tobacco product use has changed dramatically in recent years; however, little is known about current youth cessation behaviors. This study aims to assess prevalence and correlates of quit intentions and past-year quit attempts among U.S. middle and high school students who report current use of any tobacco product, cigarettes, and e-cigarettes. METHODS: Data came from the 2020 National Youth Tobacco Survey, a nationally representative cross-sectional school-based survey of students in grades 6-12. Weighed prevalence estimates of quit intentions and past-year quit attempts among users of any tobacco product, cigarettes, and e-cigarettes are presented. Multivariable-adjusted logistic regression with predictive marginals was used to assess sociodemographic correlates of quit intentions and quit attempts for each tobacco product user group. RESULTS: Quit intentions were reported by 62.5% of current users of any tobacco product, 68.1% of cigarette smokers, and 63.9% of e-cigarette users. Similarly, past-year quit attempts were reported by 65.4% of current users of any tobacco product, 65.8% of cigarettes smokers, and 67.4% for e-cigarette users. Harm perceptions toward tobacco, nicotine dependency, and the use of ≥2 tobacco products were significantly correlated with quit intentions, quit attempts, or both among different tobacco product user groups. CONCLUSIONS: Most students who use tobacco products want to quit and have attempted to do so. Development of youth-focused cessation interventions, particularly those addressing the most commonly used products, could potentially accelerate progress in a comprehensive approach to youth tobacco prevention and control.

Smoking Cessation Among U.S. Adult Smokers With and Without Chronic Obstructive Pulmonary Disease, 2018.

INTRODUCTION: More than 3 of 5 U.S. adults who have ever smoked cigarettes have quit. This study assesses the latest estimates of smoking cessation among U.S. adults with and without chronic obstructive pulmonary disease who have ever smoked cigarettes (ever smokers). METHODS: Data from 161,233 ever smokers (12.8% with chronic obstructive pulmonary disease) in the 2018 Behavioral Risk Factor Surveillance System were analyzed in 2020. Weighted percentages of quit ratios (percentage of ever smokers who quit smoking), past-year quit attempts (≥1 day), and recent successful cessation (quit ≥6 months ago) by self-reported physician-diagnosed chronic obstructive pulmonary disease status were obtained from multivariable logistic regression analyses, with adjustment for sociodemographic characteristics, health risk behaviors, depression, and asthma. RESULTS: Adults with chronic obstructive pulmonary disease who smoked had greater age-adjusted past-year quit attempts (68.8% vs 64.3%) but lower recent successful cessation (4.5% vs 5.8%) and quit ratio (53.2% vs 63.9%) than those without chronic obstructive pulmonary disease. After adjusting for covariates, adults with chronic obstructive pulmonary disease who smoked had a significantly higher percentage of past-year quit attempts but similar recent successful cessation and a significantly lower lifetime quit ratio than their counterparts without chronic obstructive pulmonary disease. CONCLUSIONS: These findings suggest that individuals with chronic obstructive pulmonary disease who try to quit smoking may be less likely to succeed than those without chronic obstructive pulmonary disease. Evidence-based treatments for smoking cessation remain an important component of a comprehensive approach to helping all adults to quit and are a particularly important element of chronic obstructive pulmonary disease management and care.

Availability and Characteristics of Hospital-Affiliated Tobacco-Cessation Programs in the U.S., 2000-2018.

INTRODUCTION: Smoking-cessation interventions can increase successful quitting, reduce healthcare costs, and enhance patients' health and well-being. This study assesses changes in the availability of hospital-affiliated smoking-cessation programs over time in the U.S. and examines the hospital characteristics associated with such programs. METHODS: Data were obtained from the American Hospital Association annual surveys. Joinpoint regressions were used to estimate the trends in having hospital-affiliated cessation programs between 2000 and 2018. A logit regression was used to estimate the association between hospital characteristics (bed size, location, teaching status, ownership) and having any hospital-affiliated cessation program. Analyses were conducted in 2019. RESULTS: The percentage of U.S. hospitals with any tobacco-cessation program increased from 23.8% (95% CI=22.7, 24.9) in 2000 to 45.5% (95% CI=44.2, 46.7) in 2018. There were sharp increases in the cessation programs between 2000 and 2002 but no change between 2015 and 2018. Hospitals with ≥200 beds (vs <200 beds; OR=2.6, 95% CI=2.5, 2.7), urban hospitals (vs rural; OR=1.3, 95% CI=1.2, 1.3), teaching hospitals (vs nonteaching; OR=1.7, 95% CI=1.7, 1.8), and private not-for-profit hospitals and public hospitals (vs private for-profit; OR=5.1, 95% CI=4.9, 5.3, and OR=3.2, 95% CI=3.0, 3.4, respectively) had higher odds of having a hospital-affiliated tobacco-cessation program. CONCLUSIONS: Less than half of U.S. hospitals reported having any hospital-affiliated cessation program in 2018. Although program prevalence nearly doubled between 2000 and 2015, this increase has not continued in recent years. Further efforts to promote and support hospital-affiliated cessation programs could be beneficial, especially among smaller, rural, nonteaching, and private for-profit hospitals.

Smoking and cessation behaviors in patients at federally funded health centers - United States, 2014.

BACKGROUND: Federally funded health centers (HCs) provide care to the most vulnerable populations in the U.S., including populations with disproportionately higher smoking prevalence such as those with lower incomes. METHODS: This study compared characteristics of adult HC patients, by cigarette smoking status, and assessed smoking cessation-related behaviors using 2014 Health Center Patient Survey data; analysis was restricted to adults with data on cigarette smoking status (n = 5583). Chi-square and logistic regression analyses were conducted. RESULTS: Overall, 28.1 % were current smokers and 19.2 % were former smokers. Current smokers were more likely to report fair/poor health (48.2 %) and a high burden of behavioral health conditions (e.g., severe psychological distress 23.9 %) versus former and never smokers. Most current smokers reported wanting to quit in the past 12 months (79.0 %) and receiving advice to quit from a healthcare professional (78.7 %). In a multivariable model, age <45, non-white race, COPD diagnosis, and past 3-month marijuana use were significantly associated with desire to quit. Few former smokers (15.2 %) reported using cessation treatment, though use was higher among those who quit within the previous year (30.6 %). CONCLUSIONS: Although most current smokers reported a desire to quit, low uptake of evidence-based treatment may reduce the number who attempt to quit and succeed. Given the burden of tobacco use, future efforts could focus on identifying and overcoming unique personal, healthcare professional, or health system barriers to connecting them with cessation treatments. Increasing access to cessation treatments within HCs could reduce smoking-related disparities and improve population health.

Youth Access to School Salad Bars in the United States-2011 to 2014.

PURPOSE: To examine differences in students' access to school salad bars across sociodemographic groups and changes in availability over time. DESIGN: Nonexperimental. SETTING: Nationally representative 2011 and 2014 YouthStyles surveys. PARTICIPANTS: A total of 833 (2011) and 994 (2014) US youth aged 12 to 17 years. MEASURES: Youth-reported availability of school salad bars. ANALYSIS: Multivariable logistic regression models were used to assess differences in school salad bar availability by sociodemographics and changes in availability from 2011 to 2014. RESULTS: Youth-reported salad bar availability differed by age in 2011 and race/ethnicity in 2014, but not by sex, income, metropolitan residence, or region in either year. Salad bars were reported by 62% of youth in 2011 and 67% in 2014; the increase was not statistically significant ( P = .07). Significant increases from 2011 to 2014 were noted among youth aged 12 to 14 years (56%-69%; P < .01), youth of non-Hispanic other races (60%-85%; P < .01), and youth in the Midwest (58%-72%; P = .01). CONCLUSION: These results suggest that youth-reported access to school salad bars does not differ significantly across most sociodemographic groups. Although overall salad bar availability did not increase significantly from 2011 to 2014, some increases were observed among subgroups. Continued efforts to promote school salad bars through initiatives such as Let's Move Salad Bars to Schools could help increase access for the nearly one-third of US youth reporting no access.

Physician Characteristics Associated With Sugar-Sweetened Beverage Counseling Practices.

PURPOSE: Frequent sugar-sweetened beverage (SSB) consumption is associated with chronic disease. Although physician counseling can positively affect patient behavior, physicians' personal characteristics may influence counseling practices. We explored SSB-related topics physicians discuss when counseling overweight/obese patients and examined associations between physicians' SSB-related counseling practices and their personal and medical practice characteristics. DESIGN: Cross-sectional survey. SETTING: DocStyles survey, 2014. PARTICIPANTS: A total of 1510 practicing US physicians. MEASURES: Physician's SSB counseling on calories, added sugars, obesity/weight gain, health effects, consumption frequency, water substitution, and referral. ANALYSIS: Adjusted odds ratios (aORs) were calculated with multivariable logistic regression, adjusting for physician's personal and medical practice characteristics. RESULTS: Most physicians (98.5%) reported SSB-related counseling. The most reported topic was obesity/weight gain (81.4%); the least reported were added sugars (53.1%) and referral (35.0%). Physicians in adult-focused specialties had lower odds than pediatricians of counseling on several topics (aOR range: 0.26-0.64). Outpatient physicians had higher odds than inpatient physicians of counseling on consumption frequency and water substitution (aOR range: 1.60-2.01). Physicians consuming SSBs ≥1 time/day (15.7%) had lower odds than nonconsumers of counseling on most topics (aOR range: 0.58-0.68). CONCLUSION: Most physicians reported SSB-related counseling; obesity/weight gain was discussed most frequently. Counseling opportunities remain in other topic areas. Opportunities also exist to strengthen SSB counseling practices in adult-focused specialties, inpatient settings, and among physicians who consume SSBs daily.