Smoking Cessation Services and Cessation Attempts across Safety-Net, Primary Care System

Background: Smoking cessation rates are low in safety-net settings, contributing to high smoking-related morbidity and mortality. Understanding factors associated with cessation attempts can inform future interventions.


Methods: Retrospective analysis using electronic health record (EHR) data on individuals with at least 3 encounters from 2016 to 2019 in the San Francisco Health Network (SFHN), a network of clinics serving publicly insured and uninsured residents in San Francisco. We measured demographics, comorbidities, and cessation treatment characteristics (i.e., counseling and pharmacotherapy) to determine associations with recent cessation attempts in multivariable analysis. We defined recent cessation attempts as change in smoking status from “current smoker” at the index visit to “former smoker” at visit 2 or 3. To better characterize sub-populations that may benefit from targeted interventions, we described characteristics of smokers with hypertension, depression, diabetes, and/or HIV.


Results: Of the 51,554 adults identified across 15 primary care clinics, 11,622 (22.7%) were current smokers. Approximately 26% made a recent cessation attempt. Medical assistant (90%) and provider counseling (73%) rates were high, while behavioral assistant counseling rate (17%) was low. All counseling types had lower odds of cessation attempts. Smokers with depression (AOR 1.18, 95%CI 1.05-1.33) and ischemic heart disease (AOR 1.36, 95%CI 1.06-1.74) had higher odds of cessation attempts. Among comorbidity groups, smokers with HIV received the lowest rates of cessation counseling.

Conclusions: Although rates of basic cessation counseling were high, these efforts had lower odds of making a cessation attempt. Using intensive interventions to target populations with comorbidities could be opportunities to increase cessation engagement.