UW-CTRI researchers and colleagues reviewed data from the 2015-2019 National Survey on Drug Use and Health of American adults and found only around half of patients who used tobacco products recalled receiving advice from healthcare providers to quit in the past year.
The research was published in the American Journal of Preventive Medicine. The study was led by former UW-CTRI postdoctoral researcher Dr. Nayoung Kim, who is now an Assistant Professor at the University of Alabama.
Data from this US nationally representative sample showed that some groups with elevated rates of tobacco use receive healthcare provider advice to quit at relatively low rates. This includes men, people with lower incomes, and those who use alcohol or cannabis.
“Given the potential harms of tobacco use, it is important for healthcare teams to offer support in quitting tobacco to all patients who are currently smoking,” said UW-CTRI Research Director Dr. Danielle McCarthy, a co-author of the paper.
She noted that these data suggest that healthcare system changes such as proactive outreach to all patients who smoke may help to close these gaps in tobacco cessation support.
Lead author Kim noted that results also suggested that healthcare providers were advising some patients to quit tobacco at especially high rates, including patients with alcohol or illicit drug use disorder diagnoses, those without college degrees, and patients with Medicaid or Medicare.
This could, in part, be attributed to Medicaid and Medicare increasingly embedding tobacco treatment quality metrics and comprehensive treatment coverage within their reimbursement structures, said UW-CTRI Researcher Dr. Jesse Kaye, a co-author.
“This incentivizes providers to deliver tobacco treatment medications and counseling while reducing patient cost barriers,” Kaye said. The varying rates could also be due to clinicians making assumptions about who needs the help, he said.
Tobacco use was particularly common among patients who use cannabis (60%) and other illicit substances (59%). These rates jump even higher among those who meet criteria for a substance use disorder: Alcohol (62%), cannabis (75%) or other illicit substances (77%). However, providers advised patients to quit at different rates depending on the other substance use.
“Patients with an alcohol or illicit drug use disorder were more likely to be advised to quit tobacco. This is very encouraging to see, since research suggests that quitting tobacco use is associated with recovery from other addictions,” Kaye said. This could reflect national and state public health campaigns urging providers to integrate tobacco treatment into other substance use treatment.
“However, it’s concerning that people who use cannabis or have a cannabis use disorder were less likely to be advised to quit tobacco,” he said. “It’s hard to say why, but providers may perceive cannabis as relatively benign, be focused on potential therapeutic benefits of cannabis, or miss the use of blunts (which contain both tobacco and cannabis). As the prevalence of cannabis use increases in the US, especially among people who also use tobacco, it is essential to provide tobacco treatment to these patients.
The low rates of advice to quit tobacco among patients who also use cannabis or alcohol underscores the continuing need for programs like the Wisconsin Nicotine Treatment Integration Project (WiNTiP) sponsored by the state of Wisconsin and led by UW-CTRI, Kaye said. WiNTiP works to help behavioral health providers to assist their patients with addressing tobacco use, regardless of the severity of the patients’ mental illness or other drug addictions.
“Every patient who smokes should be advised to quit and offered support in changing their tobacco use, regardless of their use of other substances, background, or other characteristics,” Kim stressed. “Healthcare systems can close gaps in tobacco treatment delivery to improve the health of the communities they serve.”
Kim N, Kaye JT, McCarthy DE. (2025) Disparities in Receipt of Tobacco Cessation Advice among U.S. Adult Healthcare Patients Who Use Tobacco. AJPM Focus. Online August 30, 2025.
Drs. McCarthy and Kaye’s efforts were supported by grant number R35CA197573 (PI: Michael Fiore) from the National Cancer Institute.