The Influence of Increasing Levels of Provider-Patient Discussion on Quit Behavior: An Instrumental Variable Analysis of a National Survey
Abstract
:1. Introduction
2. Methods
2.1. Data Sources and Study Population
2.2. Outcome Variables
2.3. Exposure Variables
2.4. Covariates
2.5. Instrumental Variable
2.6. Statistical Analysis
2.6.1. Instrumental Variable (IV) Analysis
2.6.2. Sensitivity Analysis
3. Results
3.1. Sample Characteristics
3.2. Associations between Provider-Patient Discussion and Quit Behavior
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Levels of Discussion | Asked and Advised (n = 2219) | Asked or Advised (n = 735) | Neither Asked or Advised (n = 1179) | |
---|---|---|---|---|
Categorical Variables | N (weighted%) | N (weighted%) | N (weighted%) | p-value a |
Sex | <0.001 | |||
Female | 1202 (51.26) | 414 (55.2) | 563 (43.14) | |
Male | 1017 (48.74) | 321 (44.8) | 616 (56.86) | |
Race/Ethnicity | <0.001 | |||
White Non-Hispanic | 1591 (78.09) | 490 (71.5) | 753 (65.36) | |
Black Non-Hispanic | 310 (11.29) | 135 (15.58) | 150 (12.68) | |
Hispanic | 197 (6.22) | 68 (8.88) | 172 (14.61) | |
Others | 121 (4.4) | 42 (4.03) | 104 (7.34) | |
Marital Status b | 0.007 | |||
Yes | 958 (56.16) | 287 (50.36) | 464 (48.79) | |
No | 1261 (43.84) | 448 (49.64) | 715 (51.21) | |
Region | <0.001 | |||
Northeast | 405 (19.07) | 95 (13.67) | 148 (12.23) | |
Midwest | 535 (29.11) | 173 (24.47) | 305 (26.8) | |
South | 772 (35.05) | 287 (41.69) | 408 (38.03) | |
West | 507 (16.77) | 180 (20.18) | 318 (22.94) | |
Education | 0.706 | |||
Less than High School | 538 (24.03) | 205 (28.37) | 284 (25.3) | |
High School Graduate | 598 (26.65) | 191 (26.69) | 300 (26.21) | |
Some College | 519 (23.29) | 170 (22.93) | 292 (23.43) | |
College or Above | 564 (26.03) | 169 (22.01) | 303 (25.07) | |
Employment | <0.001 | |||
Yes | 1083 (54.53) | 397 (56.79) | 737 (66.43) | |
No | 1136 (45.47) | 338 (43.21) | 442 (33.57) | |
Insurance | <0.001 | |||
Private | 806 (44.17) | 288 (42.54) | 505 (47.36) | |
Medicaid | 434 (17.54) | 153 (21.62) | 215 (17.18) | |
Medicare | 555 (19.5) | 147 (17.61) | 134 (8.76) | |
Others | 210 (8.56) | 52 (4.95) | 61 (5) | |
Uninsured | 214 (10.23) | 95 (13.28) | 264 (21.7) | |
Income/poverty ratio | 0.860 | |||
<1.00 | 576 (19.42) | 191 (22.56) | 307 (21.51) | |
1.00–1.99 | 569 (23.92) | 194 (23.5) | 288 (23.14) | |
2.00–3.99 | 633 (31.27) | 206 (29.95) | 343 (31.71) | |
4.00 and over | 441 (25.38) | 144 (23.99) | 241 (23.65) | |
Lung Disease c | <0.001 | |||
Yes | 1279 (53.09) | 312 (38.24) | 386 (29.27) | |
No | 940 (46.91) | 423 (61.76) | 793 (70.73) | |
CVD d | <0.001 | |||
Yes | 310 (12.07) | 65 (7.83) | 63 (4.29) | |
No | 1909 (87.93) | 670 (92.17) | 1116 (95.72) | |
Cancer e | <0.001 | |||
Tobacco Related | 87 (3.09) | 17 (2.13) | 20 (0.93) | |
Non-tobacco Related | 152 (6.3) | 43 (4.66) | 33 (2.68) | |
None | 1980 (90.61) | 675 (93.21) | 1126 (96.39) | |
Serious psychological distress f | <0.001 | |||
Yes (Kessler score ≥ 13) | 272 (13.43) | 76 (9.69) | 82 (6.61) | |
No (Kessler score < 13) | 1947 (86.57) | 659 (90.31) | 1097 (93.39) | |
Disability/limitation g | <0.001 | |||
Yes | 854 (31.38) | 196 (23.75) | 205 (12.9) | |
No | 1365 (68.62) | 539 (76.25) | 974 (87.1) | |
Continuous variables | Weighted Mean (SD) | Weighted Mean (SD) | Weighted Mean (SD) | p-value a |
Age (years) | 47.69 (14.74) | 44.23 (15.9) | 40.88 (15.12) | <0.001 |
Smoking length h (year) | 29.9 (15.19) | 26.06 (16.12) | 22.59 (15.37) | <0.001 |
Number of cigarettes smoked daily | 13.37 (9.32) | 11.08 (9.25) | 9.57 (8.07) | <0.001 |
Outcome Variable | Exposure Variable: Level of Discussion | Outcome Events/Total | Weighted % of Outcome Events | Odds Ratio (95% CI) |
---|---|---|---|---|
Intent to Quit (Yes vs. No) | Both Asked and Advised | 1611/2184 | 74% | 1.65 (1.63–1.66) Funding: |
Either Asked or Advised | 479/727 | 66% | 1.02 (0.99–1.05) | |
Neither | 726/1162 | 65% | Reference | |
Attempt to Quit (Yes vs. No) | Both Asked and Advised | 1177/2219 | 54% | 1.76 (1.75–1.77) |
Either Asked or Advised | 359/735 | 47% | 1.60 (1.57–1.63) | |
Neither | 549/1179 | 46% | Reference | |
Pharmacological quit methods (Yes vs. No) | Both Asked and Advised | 488/1177 | 40% | 1.99 (1.97–2.02) |
Either Asked or Advised | 109/359 | 31% | 1.56 (1.49–1.63) | |
Neither | 111/549 | 18% | Reference | |
Non-pharmacological quit methods (Yes vs. No) | Both Asked and Advised | 137/1177 | 10% | 2.01 (1.94–2.08) |
Either Asked or Advised | 32/359 | 11% | 2.91 (2.74–3.08) | |
Neither | 24/549 | 4% | Reference |
Outcome | Exposure Variable: Level of Discussion | Propensity Score Weighted Model ORs (95% CI) a | Multivariable Logistic Model OR (95% CI) b |
---|---|---|---|
Intent to Quit (Yes vs. No) | Both Asked and Advised | 1.74 (1.31–2.30) | 1.68 (1.32–2.14) |
Either Asked or Advised | 1.04 (0.77–1.414) | 0.97 (0.75–1.25) | |
Neither | Reference | Reference | |
Attempt to Quit (Yes vs. No) | Both Asked and Advised | 1.88 (1.49–2.38) | 1.80 (1.47–2.21) |
Either Asked or Advised | 1.24 (0.94–1.64) | 1.19 (0.92–1.55) | |
Neither | Reference | Reference | |
Pharmacological quit methods (Yes vs. No) | Both Asked and Advised | 2.01 (1.44–2.82) | 1.95 (1.41–2.70) |
Either Asked or Advised | 1.72 (1.12–2.64) | 1.54 (1.00–2.36) | |
Neither | Reference | Reference | |
Non-pharmacological quit methods (Yes vs. No) | Both Asked and Advised | 1.92 (1.01–3.66) | 1.97 (0.97–3.99) |
Either Asked or Advised | 2.57 (1.17–5.67) | 2.40 (1.09–5.30) | |
Neither | Reference | Reference |
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Liu, B.; Zhan, S.; Wilson, K.M.; Mazumdar, M.; Li, L. The Influence of Increasing Levels of Provider-Patient Discussion on Quit Behavior: An Instrumental Variable Analysis of a National Survey. Int. J. Environ. Res. Public Health 2021, 18, 4593. https://doi.org/10.3390/ijerph18094593
Liu B, Zhan S, Wilson KM, Mazumdar M, Li L. The Influence of Increasing Levels of Provider-Patient Discussion on Quit Behavior: An Instrumental Variable Analysis of a National Survey. International Journal of Environmental Research and Public Health. 2021; 18(9):4593. https://doi.org/10.3390/ijerph18094593
Chicago/Turabian StyleLiu, Bian, Serena Zhan, Karen M. Wilson, Madhu Mazumdar, and Lihua Li. 2021. "The Influence of Increasing Levels of Provider-Patient Discussion on Quit Behavior: An Instrumental Variable Analysis of a National Survey" International Journal of Environmental Research and Public Health 18, no. 9: 4593. https://doi.org/10.3390/ijerph18094593