Ask-Advise-Connect: Differential Enrollment and Smoking Cessation Outcomes Between Primary Care Patients Who Received Quitline-Delivered Treatment in Spanish vs English

• Published in: Annals of family medicine Vol. 20; no. 6; pp. 519 - 525
• Main Authors: Fennell, Bethany Shorey, Piñeiro, Bárbara, Vidrine, Damon J, Frank-Pearce, Summer G, Wetter, David W, Simmons, Vani N, Vidrine, Jennifer I
• Format: Journal Article
• Language: English
• Published: United States Annals of Family Medicine 01.11.2022; American Academy of Family Physicians
• Subjects: Care and treatment; Comparative analysis; Demographic aspects; E-health; English language; Health aspects; Health care disparities; Hispanic or Latino; Humans; Language; Language usage; Medical research; Medicine, Experimental; Nicotiana; Original Research; Primary Health Care; Smokers; Smoking Cessation; Smoking cessation programs; Spanish language; Statistics; Substance abuse; Tobacco Use Cessation Devices; United States; Quitline; primary health care; electronic health records; smoking cessation; Hispanic or Latino
• ISSN: 1544-1709; 1544-1717; 1544-1717
• DOI: 10.1370/afm.2878

This study examined differences in Quitline treatment enrollment, engagement, and smoking cessation outcomes among primary care patients preferring Spanish and English using the evidence-based tobacco treatment Ask-Advise-Connect. Ask-Advise-Connect was implemented April 2013 through February 2016 in a large safety-net health system to connect smokers with treatment via a link in the electronic health record. Rates of treatment enrollment, engagement, acceptance of nicotine replacement therapy, and smoking abstinence (self-reported and biochemically confirmed) were compared at 6 months among patients who received treatment in Spanish and English using tests. Logistic regression examined language and nicotine replacement therapy and their interaction as predictors of abstinence. The smoking status of 218,915 patients was assessed and recorded in the electronic health record. Smoking prevalence was 8.4% among patients preferring Spanish and 27.0% among those preferring English. Spanish-preferring patients were less likely to enroll in treatment (10.7% vs 12.0%, = 12.06, = .001) yet completed more counseling calls when enrolled (median = 2 vs 1, <.001). Patients who received treatment in Spanish (vs English) were twice as likely to be abstinent at 6 months (self-reported: 25.1% vs 14.5%, odds ratio [OR] = 1.98, 95% CI, 1.62-2.40; biochemically confirmed: 7.6% vs 3.7%, OR = 2.13, 95% CI, 1.52-2.97). Receipt of nicotine replacement therapy increased abstinence for all patients and language did not interact with nicotine replacement therapy to predict abstinence. Automated point-of-care approaches such as Ask-Advise-Connect have great potential to reach Spanish-preferring smokers. Those who received tobacco treatment in Spanish (vs English) demonstrated better engagement and cessation outcomes.