INTRODUCTION: Primary care delivery in the United States, including tobacco treatment, was negatively impacted by the COVID-19 public health emergency, leading to pandemic-related cessation disparities. Early in the public health emergency, rates of tobacco assessment during telehealth visits were substantially lower than during in-person visits. It is unknown if these changes persisted. METHODS: Electronic health record data were extracted and analyzed in 2024 from adult patients with ≥1 primary care visit to a primary care community-based health clinic between 01/01/2019 and 05/31/2023 (N=1,792,934 patients from 541 clinics in 17 states). The monthly percentage of visits with smoking assessment (yes/no) were examined overall and by visit modality. RESULTS: Prior to March 2020, <
1% of visits were via telehealth. In the months following, >
50% were via telehealth, leveling to 25% in the later study months. Prior to the public health emergency, >
95% of all visits included smoking assessment
the highest monthly percentage after the public health emergency declaration was 77%. For in-person visits, assessments occurred at >
95% of visits in each study month prior to March 2020, with subsequent percentages ranging from 46% (April 2020) to 95% (May 2023). In contrast, assessment during telehealth visits reached a maximum of 9% in late 2022. CONCLUSIONS: Smoking assessment remained consistently lower during the public health emergency compared with the months prior, primarily driven by lack of assessment during telehealth visits. Concerted efforts are needed to ensure that telehealth visits are leveraged to promote equitable smoking assessment and delivery of evidence-based tobacco treatment among a patient population with high rates of tobacco use.