Abstract
Objectives: To determine associations among health care access, cigarette smoking,
and change in cigarette smoking status over 7 years.
Methods: 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.
Results: 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.
Conclusions: 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.
Keywords
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© 1998 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
