Factors associated with smoking cessation attempts in a public, safety-net primary care system

Smoking cessation rates are low in safety-net settings. We conducted a retrospective analysis using electronic health record (EHR) data on adults with at least three primary care visits from 2016 to 2019 in the San Francisco Health Network (SFHN), a network of clinics serving publicly insured and uninsured San Francisco residents. We used multivariable regression to identify factors associated with 1) any cessation attempt, defined as smoking status change from "current smoker" at the index visit to "former smoker" at visit 2 or 3, and 2) a sustained cessation attempt, defined as smoking status change from "current smoker" at the index visit to "former smoker" at visits 2 and 3. We identified 7,388 adults currently smoking at the index visit; 26% (n = 1,908) made any cessation attempt, and 9% (n = 650) made a sustained cessation attempt. Factors associated with greater odds of any and sustained cessation attempts included Latinx/Hispanic ethnicity, American Indian/Alaskan Native race, and Spanish as the primary language. Meanwhile, older age, Medicaid insurance, and Chinese (i.e., Cantonese/Mandarin) as the primary language were associated with lower odds of both outcomes. Patient factors such as older age, Medicaid insurance, and speaking Chinese represent targets for improving cessation rates. Targeting interventions for these specific factors could further improve smoking cessation rates for lower cessation groups.