Comprehensive Access & Delivery Research and Evaluation Center, Iowa City VA Health Care Center, 601 Highway 6 West, Mail Stop 152, Iowa City, IA 52246, USA.
Nicotine Tob Res. 2012 Feb;14(2):123-30. doi: 10.1093/ntr/ntr141. Epub 2011 Dec 16.
Studies examining differences in clinical preventive services between smokers and nonsmokers have yielded mixed results. While some have noted reduced rates of certain preventive services among smokers relative to nonsmokers, others have reported no differences based on smoking status. These inconsistencies may be due, at least in part, to the way in which smoking status was measured. The present investigation examined variability in utilization of six common preventive services including immunization (influenza and pneumococcal) and cancer screening (breast, cervical, colorectal, and prostate) using more specific categories of smoking history and status.
Data from the 2008 Behavioral Risk Factor Surveillance System were used to estimate rates of preventive services among U.S. adults. Use of vaccination and cancer screening services across four categories of smoking status (never-smoker, daily smoker, non-daily smoker, and former smoker) were examined using multivariable logistic regression analyses adjusting for sociodemographics and health care access.
Relative to never-smokers, daily smokers had significantly reduced rates of all services with the exception of pneumococcal vaccination. Although non-daily smokers were similar to never-smokers on most outcomes, they demonstrated lower rates of mammography but were more likely to have received a recent Papanicolaou test. Except for mammography, the odds of using preventive services were 15%-47% higher among former relative to never-smokers.
Despite increased risk for respiratory disease and cancer, daily smokers are less likely to receive influenza vaccination and cancer screening. Smokers should be considered an at-risk group to be aggressively targeted for routine preventive clinical services.
研究吸烟与不吸烟者之间临床预防服务的差异，结果喜忧参半。一些研究发现，吸烟者接受某些预防服务的比例相对较低，而其他研究则报告称，吸烟者与不吸烟者之间并无差异。这些差异可能部分归因于吸烟状况的衡量方式。本研究采用更具体的吸烟史和吸烟状况分类，调查了六种常见预防服务（包括流感和肺炎球菌疫苗接种以及乳腺癌、宫颈癌、结直肠癌和前列腺癌筛查）利用情况的变异性。
本研究使用 2008 年行为风险因素监测系统的数据，估计美国成年人预防服务的使用情况。采用多变量逻辑回归分析，调整社会人口统计学和医疗保健可及性因素，对四类吸烟状况（从不吸烟者、每日吸烟者、非每日吸烟者和曾经吸烟者）的疫苗接种和癌症筛查服务的使用情况进行评估。
与从不吸烟者相比，每日吸烟者接受所有服务的比例均显著降低，除了肺炎球菌疫苗接种。虽然非每日吸烟者在大多数情况下与从不吸烟者相似，但他们接受乳房 X 光检查的比例较低，但最近接受巴氏试验的可能性较高。除了乳房 X 光检查外，与从不吸烟者相比，以前吸烟者接受预防服务的可能性高 15%-47%。
尽管每日吸烟者患呼吸道疾病和癌症的风险增加，但他们接受流感疫苗接种和癌症筛查的比例较低。应将吸烟者视为高危人群，积极针对他们开展常规预防临床服务。
