Title Smoking , respiratory disease and health service utilisation : Theparadox

Objectives: We compared need for and utilisation of health services among young, healthy smokers who did not want to quit (“the non-motivated”), and “motivated smokers”, relative to never-smokers. Methods: This cross-sectional study included 9,915 Hong Kong Police officers. We assessed smoking status, differentiating non-motivated from motivated smokers. Need was measured as number of respiratory symptoms and utilisation, as doctor consultations. Results: All smokers had significantly higher need, but relatively lower utilisation. After adjusting for other factors, the odds ratio for utilisation was 0.77 (95% CI 0.64-0.93) for motivated smokers and 0.62 (95% CI 0.50–0.77) for non-motivated, relative to never-smokers (p for trend<0.001). Conclusions: Young, relatively healthy smokers, particularly the non-motivated, utilise less health services relative to their need. This has implications for planning smoking cessation services.