Healthcare Providers are Less Likely to Ask About and Advise Cessation for Non-Cigarette Tobacco Products: NSDUH 2021–2023

Abstract

Abstract Background Tobacco use assessment during clinical encounters is often suboptimal and has focused predominantly on cigarette smoking, to the exclusion of non-cigarette tobacco use. Current estimates of assessing non-cigarette tobacco use are needed. Objective Evaluate differences in being asked about tobacco use and advice to quit by healthcare providers among exclusive cigarette and non-cigarette tobacco product users. Design and Participants Epidemiological study utilizing adult data from the 2021–2023 National Survey on Drug Use and Health ( n = 139,524). Among exclusive cigarette, cigar, smokeless tobacco, e-cigarette, and multiple tobacco product (MTP) users, we evaluated the prevalence of being asked about tobacco use being advised to quit by healthcare providers. We examined correlates of both outcomes. Main Measures Being asked about tobacco use and receiving advice to quit by a healthcare provider during the past year. Key Results Fewer people who used cigars (74.3%; p = 0.040), smokeless tobacco (72.5%; p = 0.007), and e-cigarettes (73.2%; p < 0.001) were asked about tobacco use, versus cigarette smokers (78.9%). Among those asked about tobacco use, 77.1% of cigarette smokers were advised to quit, versus people who used cigars (25.4%; p < 0.001), smokeless tobacco (46.0%; p < 0.001), e-cigarettes (0.5%; p < 0.001), and MTPs (65.4%; p < 0.001). Correlates of being Asked and Advised varied based by tobacco product. Overall, more (e.g., ≥ 6) healthcare appointments (Ask: aOR = 1.51, 95% CI = 1.22–1.87; Advise: aOR = 1.50, 95% CI = 1.14–1.97), having a lifetime chronic health condition (Ask: aOR = 1.71, 95% CI = 1.47–2.00), and older age (e.g., ≥ 50; Advise: aOR = 3.80, 95% CI = 2.96–4.89) were associated with being asked about and advised to quit tobacco use. Conclusions Non-cigarette product users were less likely than people who smoked cigarettes to be asked about or advised to quit tobacco use. Findings can inform clinical policies to help patients quit non-cigarette tobacco products and highlight the need for educational efforts and intervention development.