Health care access and smoking cessation among cancer survivors: implications for the Affordable Care Act and survivorship care.
Health care access and smoking cessation among cancer survivors: implications for the Affordable Care Act and survivorship care.
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DOI：
10.1007/s11764-015-0446-y
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发表时间：
2016-02
期刊：
影响因子：
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通讯作者：
Sorkin JD
中科院分区：
文献类型：
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作者：
Burcu M;Steinberger EK;Sorkin JD
该研究的目的是检查当前吸烟的流行率，并评估癌症幸存者的健康保险（HI）和获得护理与戒烟的关系。我们使用2009年行为风险因素监测系统调查的全国代表性数据，对18-64岁的癌症幸存者进行了横断面研究分析。我们评估了癌症幸存者中目前吸烟的患病率。此外，在排除从不吸烟者的子集中，我们评估了癌症幸存者的戒烟状态，并将其与当前吸烟者和既往吸烟者进行了比较。研究人群（N= 18，896）主要为45-64岁的白色女性。无HI的癌症幸存者（40.9%）当前吸烟的患病率显著高于有HI的癌症幸存者（19.5%）。没有HI的癌症幸存者与HI患者相比，没有戒烟的调整几率高出2倍。在那些有保险的人中，没有定期医疗保健提供者或由于费用而无法看医生或最后一次常规检查≥1年前的癌症幸存者与有更好的医疗保健的癌症幸存者相比，没有戒烟的调整几率高出60- 80%。没有HI的癌症幸存者与HI患者相比，目前吸烟率更高。在患有HI的癌症幸存者中，那些经历过医疗保健访问相关问题的人的戒烟率低于他们的同行。戒烟需要被认为是癌症幸存者预防护理的重要组成部分。迫切需要持续的患者参与和以癌症患者为中心的策略，以实现戒烟率的最佳结果，特别是对于最容易受到当前吸烟影响的年轻癌症幸存者。
The study objectives are to examine prevalence of current smoking, and to assess the association of both health insurance (HI) and access to care with smoking cessation among cancer survivors. We performed an analysis from a cross-sectional study of cancer survivors aged 18–64 years using nationally representative data from the 2009 Behavioral Risk Factor Surveillance System survey. We assessed the prevalence of current smoking among cancer survivors. Also, in a subset excluding never smokers, we assessed cessation status of cancer survivors operationalized as comparing current to former smokers. The study population (N=18,896) was predominantly 45–64 years of age, female, and white. The prevalence of current smoking was substantially greater among cancer survivors without HI (40.9 %) than for those with HI (19.5 %). Cancer survivors with no HI had 2-fold greater adjusted odds of not quitting cigarette smoking compared to those with HI. Among those with insurance, cancer survivors who did not have regular health care provider or could not see doctor due to cost or had their last routine checkup ≥1 year ago had 60–80 % fold greater adjusted odds of not quitting cigarette smoking compared to cancer survivors who had better access to health care. Cancer survivors without HI have substantially greater current smoking rates compared with those with HI. Among cancer survivors with HI, those who experienced health care access-related problems had lower cessation rates than their counterparts. Smoking cessation needs to be recognized as a crucial component of preventive care for cancer survivors. Continuous patient engagement and cancer-patient-centered strategies are urgently needed to achieve optimal results for quit rates particularly for young cancer survivors who are most susceptible to current smoking.