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Fu SS (HSR&D COE - Minneapolis), Farmer MM
(VA GLAHS HSR&D COE), Joseph AM
(University of Minnesota), Lanto AB
(VA GLAHS HSR&D COE), Riopelle DD
(VA GLAHS HSR&D COE), Yano EM
(VA GLAHS HSR&D COE), Washington DL
(VA GLAHS HSR&D COE), Sherman SE
(VA New York Harbor Healthcare System)
Objectives:
The 2000 Public Health Service Treating Tobacco Use and Dependence Clinical Practice Guidelines emphasize the role of healthcare providers in identifying tobacco users and offering treatment. Previous studies have documented racial/ethnic and gender disparities in tobacco cessation treatment in the VA. Our objectives were to: 1) examine VA provider delivery of smoking cessation services, and 2) assess the presence of racial/ethnic and gender disparities in treatment.
Methods:
We conducted a cross-sectional analysis of current smokers who responded to the Ambulatory Care VA Survey of Healthcare Experiences of Patients (SHEP) in calendar year 2002. SHEP is a national mailed survey of veterans who received outpatient care from the VA. Respondents were asked about their experience with VA health care including tobacco treatment services, as well as detailed information about health behaviors, health status, satisfaction with VA care, and socio-demographic characteristics.
Results:
In 2002, current smoking rates among SHEP survey respondents were 19.9% and varied significantly by race and gender. Smoking rates were highest among American Indians (33.9%) and African Americans (32.1%), intermediate among Latinos (21.3%), and lowest among Caucasians (18.7%) and Asian/Pacific Islanders (17.6%). Smoking rates also were higher among women (26.3%) than men (19.7%). Overall, 39.8% of smokers reported being treated by their VA healthcare provider or being referred to a tobacco treatment program. Overall, 20% of smokers reported being offered a smoking cessation medication by their VA healthcare provider. We did not observe different rates of smoking cessation treatment or offer of pharmacotherapy for racial/ethnic minority or women veterans.
Implications:
In 2002, a tobacco cessation treatment rate of only 39.8% indicates a significant gap in implementation of guideline recommendations and delivery of tobacco treatment. Although smoking rates varied by race and gender, disparities in smoking cessation treatment were not observed.
Impacts:
In 2002, VA tobacco performance measures prompted identification of tobacco use and advice to quit, but not delivery of treatment. Recently, the VA has adopted performance measures to prompt provider delivery of tobacco cessation treatment, and future research is needed to assess their impact on improving provider delivery of tobacco cessation treatment.
