Title:
The need for tobacco cessation in a free clinic population.

Abstract:
Free clinics are a unique safety net provider in that they exclusively serve the uninsured. Because free clinic providers are often volunteers, it is unclear whether uninsured patients seeking care in these clinics receive evidence-based tobacco cessation support. Here we report baseline data on prevalence and correlates of tobacco use and provider cessation advice among a sample of uninsured patients at six free clinics.
Patient exit interviews were conducted after a healthcare provider visit. Logistic regression analysis was used to assess correlates of tobacco use.
Of the 158 patients interviewed, 83 (53%) were tobacco users. Tobacco use was less likely among Hispanics (AOR 0.13 [95% CI 0.03-0.64]) and high school graduates (AOR=0.20 [95% CI 0.08-0.55]). Among tobacco users, 62% made at least one quit attempt in the past year and the majority were in the Contemplation (33%) or Preparation (39%) stage of readiness. 70% of all patients were screened in the past 3 months, although screening was more likely among tobacco users than nonusers (AOR 3.56 [95% CI 1.47-8.61]). At the current visit, 18% of tobacco users were advised to quit and 16% were asked if they were willing to quit.
The prevalence of tobacco use among uninsured free clinic patients was more than twice the national average. There is substantial opportunity to increase tobacco screening among all patients and cessation advice among tobacco users. Free clinics present an untapped opportunity to reduce tobacco harm in a population at high risk for tobacco morbidity and mortality.