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Am J Public Health. 2013 Aug;103(8):e59-65. doi: 10.2105/AJPH.2012.301112. Epub 2013 Jun 13.

Undertreatment of tobacco use relative to other chronic conditions.

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  • 1Yale Department of Emergency Medicine, 464 Congress Avenue, Suite 260, New Haven, CT 06519, USA.



We compared the likelihood that a tobacco user would receive treatment with the likelihood that an adult with another common chronic condition would receive treatment for that condition at an office visit.


We analyzed data from the 2005-2007 National Ambulatory Medical Care Survey to compare the proportion of US office visits at which tobacco users and individuals with hypertension, hyperlipidemia, diabetes, asthma, or depression received condition-specific treatment. We calculated the odds that a visit for a comparison condition would result in treatment relative to a visit for tobacco dependence.


From 2005 to 2007, 38, 004 patient visits involved at least 1 study condition. Tobacco users received medication at fewer visits (4.4%) than individuals with hypertension (57.4%), diabetes (46.2%), hyperlipidemia (47.1%), asthma (42.6%), and depression (53.3%). In multivariate analyses, the odds for pharmacological treatment of these disorders relative to tobacco use were, for hypertension, 32.8; diabetes, 20.9; hyperlipidemia, 16.5; asthma, 22.1; and depression, 24.0 (all Ps < .001). Patients with hypertension, diabetes, or hyperlipidemia were also more likely to receive behavioral counseling.


Alternate models of engagement may be needed to enhance use of effective treatments for tobacco use.

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