Risky Drinking, Current Smoking, and Attending a Past-Year Primary Care Doctor Visit

Background: Risky drinking and smoking are risk factors for severe chronic health conditions among adults in the United States. Primary care providers are generally the first to treat those with chronic health conditions, thus primary care settings have been targeted as ideal settings in which to identify individuals who engage in these risky health behaviors and provide brief interventions or refer them to treatment. However, this reliance on identifying individuals primarily in this setting may be limited if they are less likely to attend a primary care check-up to begin with. The current study aims to examine associations of risky drinking, smoking, and their co-occurrence with attendance of primary care visits.

Purpose: The study purpose is to examine if risky drinking, smoking, and co-occurring risky drinking and smoking are associated with decreased odds of visiting a primary care doctor within the past year after controlling for chronic health conditions and sociodemographic characteristics. We hypothesized that risky drinking and current smoking are associated with decreased odds of attending a past-year primary care doctor visit. Additionally, we hypothesized that risky drinking and current smoking are associated with decreased odds of attending a past-year primary care doctor visit respective to engaging in one of these risk behaviors.

Methods: The data utilized for this study is from the 2018 Behavioral Health Risk Surveillance System (BRFSS), a nationally representative study that collects prevalence figures on health behaviors, health conditions, and healthcare access barriers among U.S. adults. Past-year doctor visit was the outcome variable in this study. Risky drinking, current smoking, and comorbid risky drinking and current smoking were the primary independent variables. The following characteristics were operationalized as control variables: number of chronic health conditions, health insurance, sex, age, race, education, employment status, marital status, and metropolitan area.

Analytic Plan: Two multivariable logistic regression models were run to examine if risky drinking and current smoking were inversely associated with a past-year doctor visit among adults aged 18-64 (N=273,515). A third logistic regression model was run among adults who reported either risky drinking or current smoking to examine if co-occurring risky drinking and smoking was associated with lower odds of past-year doctor visit respective to engaging in one of these risk behaviors.

Results: Risky drinking (AOR = 0.80, 95% CI = 0.76-0.83) and current smoking (AOR = 0.65, 95% CI = 0.62-0.68) were associated with decreased odds of past-year doctor visit, adjusting for the effects of covariates. Co-occurring risky drinking and smoking was associated with lower odds of past-year doctor visit (AOR = 0.73, 95% CI = 0.67-0.79) compared to engaging in one of these risk behaviors.

Conclusions and Implications: Risky drinkers and current smokers had lower odds of visiting a primary care doctor, even after controlling for chronic health conditions and sociodemographic characteristics. Co-occurring risky drinking and smoking are substantial risk factors for not attending an annual doctor visit. These findings indicate that primary care screening and intervention services for risky drinking and smoking are reaching fewer amounts of individuals targeted for these services.