摘要：Objectives. We determined cigarette smoking prevalence, desire to quit, and tobacco-related counseling among a national sample of patients at health centers. Methods. Data came from the 2009 Health Center Patient Survey and the 2009 National Health Interview Survey. The analytic sample included 3949 adult patients at health centers and 27 731 US adults. Results. Thirty-one percent of health center patients were current smokers, compared with 21% of US adults in general. Among currently smoking health center patients, 83% desired to quit and 68% received tobacco counseling. In multivariable models, patients had higher adjusted odds of wanting to quit if they had indications of severe mental illness (adjusted odds ratio [AOR] = 3.26; 95% confidence interval [CI] = 1.19, 8.97) and lower odds if they had health insurance (AOR = 0.43; 95% CI = 0.22, 0.86). Patients had higher odds of receiving counseling if they had 2 or more chronic conditions (AOR = 2.05; 95% CI = 1.11, 3.78) and lower odds if they were Hispanic (AOR = 0.57; 95% CI = 0.34, 0.96). Conclusions. Cigarette smoking prevalence is substantially higher among patients at health centers than US adults in general. However, most smokers at health centers desire to quit. Continued efforts are warranted to reduce tobacco use in this vulnerable group. Although overall smoking rates have dropped dramatically in the past few decades, less progress has been made among certain subpopulations, including those who have less education and lower incomes: 27% of adults with less than a high-school diploma, and 28% of adults living below the federal poverty level (FPL) are cigarette smokers. 1,2 In light of slowing declines in smoking rates, the US Department of Health and Human Services (HHS) has reaffirmed its commitment to ending the tobacco epidemic, with a particular focus on the nation’s most vulnerable members. 3,4 Within HHS, the Health Resources and Services Administration (HRSA) supports health centers throughout the United States to provide access to primary care services for medically underserved and vulnerable populations. In 2011, 1128 centers served more than 20 million patients throughout the nation, including 62% racial/ethnic minorities, 36% uninsured, 40% Medicaid-insured, and 93% below 200% of the FPL. 5 Primary care settings are important intervention points for identifying tobacco use and providing appropriate counseling and treatment. As part of the primary care safety-net system, health centers are well-positioned to identify patients who smoke and ensure receipt of needed counseling and treatment. 6 The US Preventive Services Task Force recommends that clinicians provide screening and tobacco cessation interventions for adults who use tobacco products. 7 Smokers who see health care providers and receive advice to quit smoking are more likely to attempt to quit than patients who do not; however, only 2 out of 10 tobacco users nationally receive tobacco counseling during visits to their providers. 8,9 Health centers are a critical component of national efforts to address the disproportionate burden of tobacco use among vulnerable populations, and it is important to understand cigarette smoking patterns and treatment needs of patients who may have limited access to care, to guide further enhancements to services in the primary care setting. Several studies have examined tobacco use within primary care safety-net settings; however, these have focused on assessing prevalence and evaluating pilot interventions in a limited number of health centers or free clinics. 10–16 To date there have been no nationally representative studies of tobacco use and related counseling or treatment within health centers. To address this gap in the literature, the purpose of this study was to determine the prevalence of cigarette smoking, desire to quit, and receipt of tobacco-related counseling among a national sample of patients at adult health centers, as well as to identify sociodemographic and health-related factors associated with these measures.
