Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, SC.
Department of Public Health Sciences, MUSC, Charleston, SC.
Nicotine Tob Res. 2018 Sep 25;20(11):1336-1343. doi: 10.1093/ntr/ntx192.
Evidence-based cessation methods including nicotine replacement therapy (NRT), non-NRT medications, quitlines, and behavioral treatments are underutilized by smokers attempting to quit. Although a number of studies have demonstrated a relationship between state-level tobacco policies (eg, taxation, appropriations) and cessation, whether such state-level factors influence likelihood of using an evidence-based treatment is unclear. Accordingly, the aims of the present study were: (1) to describe evidence-based cessation method utilization by state and (2) to examine the effect of state-level factors on cessation method utilization above and beyond individual-level predictors.
Data were utilized from the 2010-2011 Tobacco Use Supplement to the Current Population Survey (TUS-CPS). Participants included 9232 smokers who reported a past-year quit attempt. Data on 11 state-level predictors were collated from national datasets. Analyses were based on: (1) descriptive characterization of quit method usage, (2) logistic regression models to determine state-level factors as predictors of quit method utilization, controlling for individual-level predictors, (3) cluster analyses grouping states with similar state-level factors, and (4) examination of cluster as a predictor of cessation method.
Tobacco control appropriations significantly predicted NRT, quitline, and behavioral treatment utilization. Additional state-level factors that demonstrated significant relationships included Medicaid coverage of non-NRT medications and behavioral treatment, tobacco tax rate, smoking prevalence, and percentage of population uninsured. State clustering significantly predicted quit method across all four methods.
State-level factors influence the likelihood of residents utilizing evidence-based quit methods. Results are discussed in terms of implications for tobacco policy at the state level.
Results from the present study highlight state tobacco control appropriations as a robust predictor of evidence-based cessation method utilization. Other significant state-level predictors of evidence-based cessation method utilization included Medicaid coverage of non-NRT medications and behavioral treatment, tobacco tax rate, smoking prevalence, and percentage of population uninsured. Moreover, state-level predictors clustered together to significantly predict evidence-based cessation method utilization. Thus, increasing tobacco control appropriations, extending health insurance coverage, maximizing revenue from tobacco taxation and tobacco settlements, and ultimately decreasing smoking prevalence are important targets for individual states to promote utilization of evidence-based cessation methods.
包括尼古丁替代疗法（NRT）、非 NRT 药物、戒烟热线和行为治疗在内的循证戒烟方法在试图戒烟的吸烟者中未得到充分利用。尽管许多研究表明州级烟草政策（如税收、拨款）与戒烟之间存在关联，但州级因素是否会影响使用循证治疗的可能性尚不清楚。因此，本研究的目的是：（1）描述各州循证戒烟方法的使用情况；（2）检验州级因素对戒烟方法使用的影响，这些影响超出了个体预测因素。
利用 2010-2011 年烟草使用补充当前人口调查（TUS-CPS）的数据。参与者包括 9232 名报告过去一年有戒烟尝试的吸烟者。从国家数据库中收集了 11 个州级预测因素的数据。分析基于：（1）戒烟方法使用情况的描述性特征；（2）Logistic 回归模型，确定州级因素作为戒烟方法使用的预测因素，控制个体预测因素；（3）将具有相似州级因素的州分组进行聚类分析；（4）检验聚类作为戒烟方法的预测因素。
烟草控制拨款显著预测了 NRT、戒烟热线和行为治疗的使用。其他具有显著关系的州级因素包括非 NRT 药物和行为治疗的医疗补助覆盖范围、烟草税率、吸烟率和未参保人口百分比。州聚类显著预测了所有四种方法的戒烟方法。
州级因素影响居民使用循证戒烟方法的可能性。结果从州级烟草政策的角度进行了讨论。
本研究的结果强调了州级烟草控制拨款是预测循证戒烟方法使用的有力指标。其他对循证戒烟方法使用有显著预测作用的州级因素包括非 NRT 药物和行为治疗的医疗补助覆盖范围、烟草税率、吸烟率和未参保人口百分比。此外，州级预测因素聚类在一起，对循证戒烟方法的使用有显著的预测作用。因此，增加烟草控制拨款、扩大健康保险覆盖范围、最大限度地从烟草税收和烟草和解中获得收入，以及最终降低吸烟率，是各州促进循证戒烟方法使用的重要目标。
