The purpose of this study was to determine how often smoking patients receive quit advice and if patient age, and number and type of clinical encounters are associated with odds of receipt. Behavioral Risk Factor Surveillance System (BRFSS) 2000 data were used to study 10,582 smokers (aged ³ 18) having ³ 1 of three types of clinical encounters in the past year: routine checkups, other physician encounters, or dental visits. Multivariate-adjusted odds ratios (ORs) for quit advice by patient age, encounter type, and number of doctor's visits were calculated. Almost 55% of patients were advised to quit smoking. There was a 4-23% chance of receiving quit advice at any given doctor's visit. Odds of receiving advice did not increase with increasing number of visits. With advancing age, men were more likely, women less likely, to receive quit advicebut only significantly for White men. Compared to those having dental visits, ORs for receiving quit advice for patients having checkups and other physician encounters were 3.35 (95% CI 2.ll, 5.31) and 3.03 (95%CI 1.32, 6.97) respectively. These cross-sectional data suggest that whereas a small majority of smoking patients are advised to quit at some clinical encounter, smoking patients are not advised to quit at the majority of encounters. Being young and male, or seeing dentists rather than doctors made patients less likely to receive quit adviceas did having lower education or BMI, no insurance or coverage other than military or private, not having asthma, or not having breast exams or follow-up Papanicolaou smears if female. Based on a previously-reported absolute quit difference of 1.9%, if smoking patients received quit advice just once at any of their encounters with physicians in a year, at least 800,000 more U.S. smokers would quit at an economic savings of $2.4 billion.

Hypertension, a medical condition, predisposes to other cardiovascular diseases, and can be impacted by the social determinants of health (SDOH). Self-measured blood pressure monitoring (SMBP) is an evidence-based approach to hypertension control, but not much is known about the influence of SDOH on SMBP. This dissertation aims to: 1) highlight the SDOH factors whose relationship with SMBP have been explored in research studies; 2) examine the relationship between SDOH and SMBP among United States (U.S.) adults with high blood pressure; and 3) examine the current state of SMBP in the U.S., highlight policy implications from the empirical study and provide recommendations. Aims 1 and 2 were informed by an adapted SDOH framework, which comprised of upstream structural determinants, and downstream intermediary determinants. Aim 1 was achieved via a scoping review of studies across three databases following the PRISMA-SCR checklist. Aim 2 was achieved via a cross-sectional analysis of data from adult respondents to the 2019 Behavioral Risk Factor Surveillance System, with self-reported hypertension. Bivariate and Multiple Logistic regression analyses were conducted. Aim 3 involved a literature scan on policy concerning SMBP, highlighting the policy implications of findings from the empirical study, and providing recommendations for policy/practice. For aim 1, findings suggest that research studies examined the relationship of relatively more structural determinants, than the few, but highly significant intermediary determinants, with SMBP. For aim 2, looking at the structural determinants, males and those who identify as Black and other minority racial groups were more likely to report SMBP. For intermediary determinants, respondents who consumed fruits, vegetables, and exercised were likely to report SMBP, while those who smoke, who drink, and those with poor mental health days were less likely to report SMBP. Respondents with health coverage and whose provider recommended SMBP were likely to report SMBP use. Those ≥65 years were more likely to report SMBP. For aim 3, I recommend that the Centers for Medicare and Medicaid Services lead policy efforts on SMBP reimbursements. Also, healthcare practices should strengthen their technological infrastructure e.g., telehealth to promote access, and Electronic Health Records to promote efficient data collection and tracking.