Multivariable analyses of the association between unhealthy substance use and receipt of preventive services by primary care patients* between 2007 and 2009 in Boston, Massachusetts
| Flu vaccination OR (95% CI) | Pap smear OR (95% CI) | Mammogram OR (95% CI) | Colorectal cancer screening OR (95% CI) | |
| Unhealthy substance use | 0.80 (0.66 to 0.97) | 0.95 (0.70 to 1.29) | 0.69 (0.59 to 0.80) | 0.93 (0.74 to 1.17) |
| Older age† | 1.49 (1.31 to 1.70) | 0.30 (0.26 to 0.35) | 1.55 (1.26 to 1.90) | 0.98 (0.85 to 1.14) |
| Female | 0.74 (0.68 to 0.82) | NA | NA | 0.91 (0.80 to 1.04) |
| Public insurance‡ | 1.10 (0.98 to 1.24) | 0.92 (0.81 to 1.06) | 0.86 (0.74 to 0.99) | 0.78 (0.66 to 0.93) |
| Black race | 0.79 (0.69 to 0.90) | 1.11 (0.98 to 1.26) | 1.05 (0.93 to 1.19) | 0.94 (0.85 to 1.04) |
| English-speaking | 0.94 (0.77 to 1.14) | 0.84 (0.65 to 1.08) | 0.75 (0.66 to 0.86) | 1.01 (0.84 to 1.22) |
| Medical comorbidity§ | 1.54 (1.17 to 2.02) | 0.73 (0.57 to 0.93) | 0.88 (0.74 to 1.05) | 0.98 (0.92 to 1.05) |
| Psychiatric comorbidity¶ | 1.20 (1.13 to 1.29) | 0.93 (0.74 to 1.18) | 0.73 (0.64 to 0.83) | 1.04 (0.93 to 1.15) |
| High primary-care-practice utilisation** | 1.89 (1.70 to 2.11) | 1.02 (0.78 to 1.33) | 1.60 (1.14 to 2.26) | 1.59 (1.40 to 1.81) |
↵* The variable unhealthy substance use was included in all models as it is the primary predictor of interest.
↵† Analyses of flu vaccination receipt compared patients aged 65–75 with those aged 21–64; analyses of Papanicolou (Pap) smear receipt compared patients aged 50–64 with those aged 21–49; analyses of mammogram receipt compared patients aged 50–69 with those aged 40–49; analyses of receipt of colorectal cancer screening compared patients aged 65–75 with those aged 50–64.
↵‡ Defined as Free Care, Medicaid or Commonwealth Care (the new subsidised Massachusetts insurance programme).
↵§ Defined as Charlson–Deyo Score of 1 or greater.
↵¶ Defined as diagnosis of anxiety, bipolar, depression, post-traumatic stress disorder, panic or schizophrenia on medical problem list.
↵** Defined as at least six primary care visits in the past 2 years for patients eligible for mammograms and flu vaccination, and at least six primary care visits in the past 3 years for patients eligible for Pap smears and colorectal cancer screening.