Do Health Care Providers Differentiate between Daily and Nondaily Smokers when Counseling for Smoking Cessation? Analysis by Race/Ethnicity

Objective: Nondaily smokers (NDS) may not receive cessation counseling due to perceptions that nondaily smoking is less hazardous and that NDS can quit unassisted. We investigated differences in provision of guideline-based cessation services -- i.e., ask, advise, assist, arrange follow-up (“4 A's”)? by smoker type (NDS and DS) and race/ethnicity as well as the interaction between race and smoker type. Methods: Participants were NDS (smoked 4-24 days in the last 30) and DS (smoked >25 days in the past month) recruited using an online panel. An online questionnaire gathered self-reported data from smokers regarding health care professional-provided tobacco treatment over the last 12 months. The 1587 participants who had at least one doctor visit in the past 12 month included native NDS, converted NDS, light DS, and heavy DS. Results: Multivariable analysis showed that, there were no statistically significant differences on the odds of being asked about smoking between different types of smokers. However, compared to native nondaily smokers, Latino and White converted nondaily smokers (Latinos, AOR = 2.02, 95% CI 1.09, 3.74 and Whites, AOR= 2.33, 95% CI 1.27, 4.29), light daily smokers (AOR = 2.82, 95% CI 1.41, 5.63, and AOR= 3.72, 95% CI, 1.92, 7.22, respectively) and heavy daily smokers (AOR = 4.11, 95% CI 2.01, 8.43 and AOR = 6.85, 95% CI 3.39, 13.81, respectively) had increasing odds of reporting being advised to quit by their health care providers. Among African American smokers, converted nondaily smokers (AOR = 2.11, 95% CI 1.01, 4.44) and heavy daily smokers (AOR = 2.92, 95% CI 1.35, 6.28) were more likely to receive assistance in quitting than native nondaily smokers. Among African Americans, heavy daily smokers' had greater odds of having follow-up arranged compared to native nondaily smokers (AOR=3.06, 95% CI 1.08, 8.70) and among Latinos, these rates were only statistically significant for converted nondaily smokers compared to native nondaily smokers (AOR= 2.80, 95% CI 1.25, 6.26). Among Whites, light daily smokers had the greatest odds of having their health care provider arrange follow-up (AOR= 10.81, 95% CI 1.37, 85.12) compared to native nondaily smokers. Conclusions: Daily smokers report greater engagement by health care providers compared to NDS with regard to smoking cessation. These findings such suggest the primary care providers are ascribing less risk to NDS than DS. Educational efforts are needed to change this tendency among primary care providers. In addition, the patterns identified were similar across the three ethnic groups studied here.