Health care access and seven-year change in cigarette smoking. The CARDIA Study.
OBJECTIVE
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.
Kiefe
C I
CI
University of Alabama at Birmingham, Division of Preventive Medicine 35205-4785, USA.
Williams
O D
OD
Greenlund
K J
KJ
Ulene
V
V
Gardin
J M
JM
Raczynski
J M
JM
D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008489:Medical Indigency / Q000706:statistics & numerical data; D015995:Prevalence; D011446:Prospective Studies; D012008:Recurrence; D012907:Smoking / Q000453:epidemiology*; D016540:Smoking Cessation / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013223:Statistics as Topic; D014481:United States / Q000453:epidemiology