Introduction: 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.
Methods: 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.
Results: 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.
Conclusions: 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.