Health care access and seven-year change in cigarette smoking. The CARDIA Study

UMMS Affiliation

Department of Quantitative Health Sciences

Publication Date


Document Type



Adult; Cross-Sectional Studies; Female; Health Services Accessibility; Humans; Insurance, Health; Male; Medical Indigency; Prevalence; Prospective Studies; Recurrence; Smoking; Smoking Cessation; Socioeconomic Factors; Statistics as Topic; United States


Bioinformatics | Biostatistics | Epidemiology | Health Services Research


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.


Am J Prev Med. 1998 Aug;15(2):146-54.

Journal/Book/Conference Title

American journal of preventive medicine

PubMed ID


Related Resources

Link to Article in PubMed