Effect of Gaining Insurance Coverage on Smoking Cessation in Community Health Centers: A Cohort Study

Bailey, Steffani R.; Hoopes, Megan; Heintzman, John; O’Malley, Jean P.; Hatch, Brigit; Angier, Heather; Fortmann, Stephen P.; DeVoe, Jennifer E.

doi:10.1007/s11606-016-3781-4

Cited by 34 publications

(45 citation statements)

References 38 publications

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“…Previous research has shown insurance coverage to have a significant positive effect on smoking cessation rates among low-income adults. 6,7,8 Therefore, increased access to healthcare through Medicaid coverage is likely to increase the likelihood that an individual would attempt to quit smoking, both via provider counseling during routine healthcare visits, as well as with outpatient smoking cessation pharmacotherapies. Although we lack longer-term data, this sizable increase in smoking cessation might lead to significant reductions in morbidity and mortality caused by smoking, and related federal and state Medicaid expenditures.…”

Section: Discussionmentioning

confidence: 99%

“…5 Previous studies have suggested that insurance coverage has a positive effect on smoking cessation. 6,7,8 More specifically, prior research has shown that more generous coverage of smoking cessation in Medicaid before ACA Medicaid expansions was associated with 3 percentage-point increase in smoking cessation, 8 while a study conducted in Massachusetts showed that 40% of recent enrollees used tobacco smoking cessation benefits in the first 2.5 years of enrolling. 9 Further, a cohort study of patients in community health centers showed that recent enrollees had a 40% increase in the odds of quitting smoking and triple the odds of ordering smoking cessation medication.…”

Section: Introductionmentioning

confidence: 99%

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Medicaid Coverage Expansions and Cigarette Smoking Cessation Among Low-income Adults

et al. 2017

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Introduction Expanding Medicaid coverage to low-income adults may have increased smoking cessation through improved access to evidence-based treatments. Our study sought to determine if states’ decisions to expand Medicaid increased recent smoking cessation. Methods Using pooled cross-sectional data from the Behavioral Risk Factor Surveillance Survey for the years 2011–2015, we examined the association between state Medicaid coverage and the probability of recent smoking cessation among low-income adults without dependent children who were current or former smokers (n=36,083). We used difference-in-differences estimation to examine the effects of Medicaid coverage on smoking cessation, comparing low-income adult smokers in states with Medicaid coverage to comparable adults in states without Medicaid coverage, with ages 18–64 years to those ages>=65 years. Analyses were conducted for the full sample and stratified by sex. Results Residence in a state with Medicaid coverage among low-income adult smokers ages 18–64 years was associated with an increase in recent smoking cessation of 2.1 percentage points (95%CI: 0.25, 3.9). In the comparison group of individuals ages>=65 years, residence in a state with Medicaid coverage expansion was not associated with a change in recent smoking cessation (−0.1 percentage point, 9% CI: −2.1, 1.8). Similar increases in smoking cessation among those ages 18–64 years were estimated for females and males (1.9 and 2.2 percentage-point, respectively). Conclusion Findings are consistent with the hypothesis that Medicaid coverage expansions may have increased smoking cessation among low-income adults without dependent children via greater access to preventive healthcare services, including evidence-based smoking cessation services.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Medicaid Coverage Expansions and Cigarette Smoking Cessation Among Low-income Adults

et al. 2017

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“…They conclude that obtaining insurance leads to increased tobacco cessation. 2 Although not the focus of their research, their study showed that primary care providers prescribed tobacco cessation medications to only a small proportion of smokers, less than 27% of insured and 12 % of uninsured patients. Primary care providers have consistently under performed in providing tobacco cessation services despite evidence-based guidelines.…”

mentioning

confidence: 99%

“…3 As Bailey and colleagues point out, this higher rate of prescriptions does not fully explain their results, particularly since the trend toward higher quit rates occurred even among patients in which no cessation medication was ordered. 2 One possibility is referral to smoking cessation counseling, a variable not captured in this study. Another is that obtaining insurance may be a marker of desire for healthier living.…”

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confidence: 99%

Capsule Commentary on Bailey et al., Effect of Gaining Insurance Coverage on Smoking Cessation in Community Health Centers: A Cohort Study

McKenna

2016

J GEN INTERN MED

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W ith passage of the Affordable Care Act (ACA) in 2010, more than 8 million Americans obtained insurance coverage by 2014, over half via Medicaid. 1 Proponents of the ACA argued it would achieve major public health milestones by tying insured patient populations to evidence-based public health initiatives. As tobacco smoking continues to be the leading cause of preventable death in the US, Bailey and colleagues focused on the effects of obtaining Medicaid insurance coverage in a cohort of previously uninsured smokers. They found a three-fold increase in prescription of smoking cessation aids and an impressive 40 % decrease in smoking over 24 months of follow-up (though the absolute reduction was only 3 %). They conclude that obtaining insurance leads to increased tobacco cessation. 2 Although not the focus of their research, their study showed that primary care providers prescribed tobacco cessation medications to only a small proportion of smokers, less than 27% of insured and 12 % of uninsured patients. Primary care providers have consistently under performed in providing tobacco cessation services despite evidence-based guidelines. 3 As Bailey and colleagues point out, this higher rate of prescriptions does not fully explain their results, particularly since the trend toward higher quit rates occurred even among patients in which no cessation medication was ordered. 2 One possibility is referral to smoking cessation counseling, a variable not captured in this study. Another is that obtaining insurance may be a marker of desire for healthier living. Another possibility is that the results are spurious, given the relatively small difference between the two groups and that the results are based on propensity score matching. Several previous studies have shown benefit from obtaining health insurance including reducing mortality 4 and increasing use of preventive services. 5 This study suggests that another potential benefit for gaining insurance is a reduction in smoking. If this is true, the potential cost savings for universal coverage could be huge, given the long-term consequences of smoking on health.

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“…Other studies have found that gaining insurance coverage leads to reduced rates of smoking. 5 This would suggest that providing insurance to the uninsured, bundling into the insurance coverage incentives for both providers and patients to reduce smoking and paying for both pharmacologic and behavioral interventions may optimize tobacco cessation. Future studies need to examine the impact of combining these interventions.…”

mentioning

confidence: 99%

Capsule Commentary on Huskamp et al., Effects of Global Payment and Accountable Care on Tobacco Cessation Service Use: An Observational Study

Jackson

2016

J GEN INTERN MED

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Effect of Gaining Insurance Coverage on Smoking Cessation in Community Health Centers: A Cohort Study

Cited by 34 publications

References 38 publications

Medicaid Coverage Expansions and Cigarette Smoking Cessation Among Low-income Adults

Medicaid Coverage Expansions and Cigarette Smoking Cessation Among Low-income Adults

Capsule Commentary on Bailey et al., Effect of Gaining Insurance Coverage on Smoking Cessation in Community Health Centers: A Cohort Study

Capsule Commentary on Huskamp et al., Effects of Global Payment and Accountable Care on Tobacco Cessation Service Use: An Observational Study

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