Kiefe C I, Williams O D, Greenlund K J, Ulene V, Gardin J M, Raczynski J M
University of Alabama at Birmingham, Division of Preventive Medicine 35205-4785, USA.
Am J Prev Med. 1998 Aug;15(2):146-54. doi: 10.1016/s0749-3797(98)00044-0.
To determine associations among health care access, cigarette smoking, and change in cigarette smoking status over 7 years.
A cohort of 4,086 healthy young adults was followed from 1985-1986 through 1992-1993. Participants were recruited from four urban sites balanced on gender, race (African Americans and whites), education (high school or less, and more than high school), and age (18-23 and 24-30). Outcome measures were smoking status at Year 7, as well as 7-year rates of smoking cessation and initiation.
For each of three access barriers reported at Year 7 (lack of health insurance, lack of regular source of medical care, and expense), participants experiencing the barrier had a higher prevalence of smoking, quit smoking less frequently, and started smoking more frequently; e.g., only 15% of participants with health insurance lapses quit smoking over the 7-year period, compared with 26% of those with insurance (P < 0.001). Results were similar for each race/gender stratum, and persisted after adjustment for usual markers of socioeconomic status: education, income, employment, and marital status.
Health care access was associated with lower prevalence of smoking and beneficial 7-year changes in smoking, independent of socioeconomic status. The possibility that this is a causal relationship has implications in the prevention of cardiovascular disease, cancer and multiple other smoking-related diseases, and deserves further exploration.
确定医疗保健可及性、吸烟与7年间吸烟状况变化之间的关联。
对4086名健康的年轻成年人组成的队列进行了追踪，时间从1985年至1986年持续到1992年至1993年。参与者从四个城市地点招募，在性别、种族（非裔美国人和白人）、教育程度（高中及以下和高中以上）和年龄（18 - 23岁和24 - 30岁）方面保持平衡。结局指标为第7年的吸烟状况，以及7年的戒烟和开始吸烟率。
对于第7年报告的三个医疗保健可及性障碍（缺乏医疗保险、缺乏常规医疗保健来源和费用）中的每一个，经历该障碍的参与者吸烟患病率更高，戒烟频率更低，开始吸烟频率更高；例如，在7年期间，只有15%的医疗保险中断的参与者戒烟，而有保险的参与者这一比例为26%（P < 0.001）。每个种族/性别分层的结果相似，在对社会经济地位的常规指标（教育、收入、就业和婚姻状况）进行调整后仍然成立。
医疗保健可及性与较低的吸烟患病率以及有益的7年吸烟变化相关，独立于社会经济地位。这可能是一种因果关系，这对预防心血管疾病、癌症和多种其他与吸烟相关的疾病具有启示意义，值得进一步探索。
