Medicaid expansion linked to smoking cessation in Pitt analysis

Nov. 13--Low-income adults in states that expanded Medicaid under the Affordable Care Act were more likely to quit cigarettes than those in states that didn't offer Medicaid expansion, according to a University of Pittsburgh Graduate School of Public Health analysis.

Researchers analyzed responses from more than 36,000 low-income adults without dependent children to an annual telephone health behavior survey by the Centers for Disease Control and Prevention.

In comparing smoking-related answers to the survey, they found 8.1 percent of the newly covered low-income adults reported that they'd quit smoking in the prior year, compared with 6 percent of low-income adults in the 19 states without expanded Medicaid coverage.

The findings were published online and scheduled for an upcoming issue of the journal Medical Care.

"Smoking cessation is notoriously difficult to achieve," said senior author Marian Jarlenski, assistant professor in Pitt Public Health's Department of Health Policy and Management. "The sizable increase we found in smoking cessation might lead to significant reductions in death and diseases caused by smoking, and the taxpayer-funded health care expenditures that come with treating them."

Cigarette smoking is the leading cause of preventable disease and death in the United States, accounting for more than 480,000 deaths every year, or 1 of every 5 deaths, according to the CDC.

"There are many explanations for why new Medicaid enrollees may be motivated to quit smoking when they engage with health care services," said lead author J. Wyatt Koma, now a research assistant in health care with NORC at the University of Chicago. "During the Medicaid enrollment process, people are asked whether they smoke, so it's possible that this question might prompt them to start contemplating smoking cessation. After enrollment, they have access to primary care visits, where their clinician is likely to counsel them about quitting. And studies have shown that people in states with Medicaid expansion are much more likely to get prescriptions for smoking cessation medications, which are covered by Medicaid."

However, Koma said the 8.1 percent rate of smoking cessation is still low when compared to the 68.9 percent of adults who say they want to quit.

"The question remains whether or not there will be sufficient funds and support to continue to improve the health outcomes of these vulnerable populations moving forward," he said.

The research was funded by the Pitt Honors College Chancellor's Research Fellowship and the National Institutes of Health's Building Interdisciplinary Research Careers in Women's Health program grant.

Ben Schmitt is a Tribune-Review staff writer. Reach him at 412-320-7991, bschmitt@tribweb.com or via Twitter at @Bencschmitt.

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