Researchers from Boston Medical Center (BMC) and Boston University School of Medicine (BUSM) have identified unhealthy substance use as a risk factor for not receiving all appropriate preventive health services. The findings, which currently appear in BMJ Open, identify unhealthy substance use as a barrier to completion of mammography screening and influenza vaccination.

Cancer and influenza are among the leading causes of mortality in the United States. Influenza is preventable, in part, through vaccination, and mortality from cervical, breast and colorectal cancer can be reduced through routine screening. Nevertheless, many eligible U.S. adults do not receive these recommended preventive services, in particular, low-income persons, racial and ethnic minorities, the uninsured and the foreign-born.

Despite this knowledge, and the implementation of interventions targeting these groups, preventive services are still underused, which has led some to believe that high-risk “pockets” of the population may account for gaps in service receipt.

“Persons with unhealthy substance use (for alcohol, the spectrum that ranges from risky use to dependence; for drugs, the spectrum from any illicit drug use, including prescription drugs to dependence), represent one such “pocket,” said lead author Karen Lasser, MD, MPH, a primary care physician at BMC as well as an associate professor of medicine at BUSM.

The researchers analyzed data from 4,804 women eligible for mammograms, 4,414 eligible for Papanicolou (Pap) smears, 7,008 persons eligible for colorectal cancer (CRC) screenings, and 7,017 persons eligible for influenza vaccination. All patients were screened for unhealthy substance use.

Among the nearly 10,000 patients eligible for one or more of the preventive services of interest, 10 percent screened positive for unhealthy substance use. Compared to women without unhealthy substance use, women with unhealthy substance use received mammograms less frequently (75.4 percent vs. 83.8 percent), but Pap smears no less frequently (77.9 percent vs. 78.1 percent). Persons with unhealthy substance use received CRC screenings no less frequently (61.7 percent vs. 63.4 percent), yet received influenza vaccination less frequently (44.7 percent vs. 50.4 percent). “We speculate that persons with unhealthy substance use who are not engaged in primary care at the high thresholds used in these analyses may have substantially lower receipt of preventive services,” said Lasser.

According to the researchers future interventions to promote mammography screening might target women with unhealthy substance use, and those to promote influenza vaccination might target both men and women with unhealthy substance use. “Clinical interventions could embed mammography screening and influenza vaccination in other services delivered to individuals with substance use problems. In addition, training interventions could enhance skills and systems for health care personnel who screen for substance use disorders to include referrals for preventive health services,” she added.

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