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Smoking-Related Disparities in Health Care Access and Utilization Among Adults

Teferra, Andreas Admassu

Abstract Details

2022, Doctor of Philosophy, Ohio State University, Public Health.
Background. Cigarette smoking continues to be a major cause of illness, disability, and death and a significant burden in the health care system of the United States. Yet, gaps remain in our understanding of health care access and use related to smoking. Guided by comprehensive health services frameworks and recent data, this research explored smoking-related disparities in health care access and utilization among adults. We used large statewide surveys conducted in Ohio to (1) assess trends in health care access measures among low-income adults by smoking status following Ohio’s Medicaid expansion and (2) describe factors associated with overuse of emergency departments (EDs) and underuse of preventive care among adult smokers. Using a related follow-up panel survey, we (3) examined the relationship between smoking and COVID19-related health care use and testing during the early months of the COVID-19 pandemic in Ohio. Methods. We assessed trends in five health care access measures by smoking status covering the pre- (i.e., 2012) and post-Medicaid expansion (i.e., 2015 to 2019) periods in Ohio using survey-weighted multivariable logistic regression. We carried out the analysis in ten multiply imputed datasets to handle missing data. We built multivariable descriptive models for factors associated with ED overuse and preventive care underuse in ten multiply imputed datasets accounting for potential contextual determinants of care. We examined the association between smoking and COVID-19-related health care use and COVID-19 testing using survey-weighted multivariable logistic regression models. Results. Compared to the pre-expansion period, we found improvements in unmet dental care needs, unmet medical exam or supply needs, and the ability to pay medical bills among smokers. However, we did not find an improvement in having a usual source of care (USC) or unmet mental care needs. We also found that progress in access measures among smokers is not as notable as that of non-smokers. ED overuse was related to poorer self-rated health, low income, Medicaid insurance or uninsurance, mental distress, and chronic health conditions. Underuse of preventive care was associated with lack of a USC, uninsurance, low income, and being unmarried or male. We found that current smokers, compared to never smokers, were more likely to seek both virtual and in-person care for COVID-19-related concerns during the early months of the pandemic, although differences in COVID-19 testing were short-lived. Conclusion. This research improved the existing knowledge of health care disparities by characterizing access measures and determinants of use among smokers. The study's findings could be leveraged to support policies and interventions to further reduce unmet care needs, improve preventive care use, and lower avoidable health care spending attributed to smoking. The research will also serve as an input for future research examining the long-term impact of the COVID-19 pandemic on health care access and use among smokers.
Amy Ferketich (Advisor)
Jeffrey Wing (Committee Member)
Wendy Xu (Committee Member)
Megan Roberts (Committee Member)
Bo Lu (Committee Member)
249 p.

Recommended Citations

Citations

  • Teferra, A. A. (2022). Smoking-Related Disparities in Health Care Access and Utilization Among Adults [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu165833773396668

    APA Style (7th edition)

  • Teferra, Andreas. Smoking-Related Disparities in Health Care Access and Utilization Among Adults. 2022. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu165833773396668.

    MLA Style (8th edition)

  • Teferra, Andreas. "Smoking-Related Disparities in Health Care Access and Utilization Among Adults." Doctoral dissertation, Ohio State University, 2022. http://rave.ohiolink.edu/etdc/view?acc_num=osu165833773396668

    Chicago Manual of Style (17th edition)