Abstract
Medicaid-insured individuals who smoke experience disparities in quitting and are a priority population for assistance. This retrospective cohort study of Arizona Smokers’ Helpline clients (Jan 2014–Mar 2019) examined the association between insurance status, treatment, and smoking cessation. When compared to clients with non-Medicaid insurance or no insurance, clients with Medicaid (26%) were more likely to be female, referred directly to the ASHLine by a healthcare or community partner, smoke in the home, and report having a mental health condition. They also were less likely to utilize cessation medication and reported receiving less social support to quit. Controlling for these and other theoretically relevant variables, insurance status was stratified (Medicaid, non-Medicaid, and uninsured), and quit outcomes were compared by level of treatment (4 treatment groups: more and less than 3 coaching sessions and cessation medication use yes/no). Compared to clients who received 3+ coaching sessions, those who had less than 3 coaching sessions had significantly lower adjusted odds of quitting. Results were similar regardless of cessation medication use or insurance status. There is no indication that treatment effects differ by insurance status. While insurance status appears to proxy for other important factors like low social and economic status and higher comorbidity prevalence, in a quitline setting, quitting is associated with additional, high-quality coaching. Where coaching sessions may offset social and economic barriers to quitting, quitlines may consider focusing on assisting Medicaid-insured clients to connect and engage with treatment.
Similar content being viewed by others
References
Tobacco Control Legal Consortium. Federal Regulation of Tobacco: Impact on State and Local Authority. Saint Paul, MN; 2009:1-21. https://publichealthlawcenter.org/sites/default/files/resources/tclc-fda-impact.pdf. Accessed May 30, 2020.
Jamal A, King BA, Neff LJ, et al. Current Cigarette Smoking Among Adults — United States, 2005–2015. Morbidity and Mortality Weekly Report. 2016;65(44):1205-1211. doi:https://doi.org/10.15585/mmwr.mm6544a2
Wang TW, Asman K, Gentzke AS, et al. Tobacco Product Use Among Adults — United States, 2017. Morbidity and Mortality Weekly Report. 2018;67(44):1225-1232. doi:https://doi.org/10.15585/mmwr.mm6744a2
Trinidad DR, Pérez-Stable EJ, White MM, et al. A nationwide analysis of US racial/ethnic disparities in smoking behaviors, smoking cessation, and cessation-related factors. American Journal of Public Health. 2011;101(4):699-706. doi:https://doi.org/10.2105/AJPH.2010.191668
Kulak JA, Cornelius ME, Fong GT, et al. Differences in Quit Attempts and Cigarette Smoking Abstinence Between Whites and African Americans in the United States: Literature Review and Results From the International Tobacco Control US Survey. Nicotine Tobacco Research. 2016;18 Suppl 1:S79-87. doi:https://doi.org/10.1093/ntr/ntv228
Graham H, Inskip HM, Francis B, et al. Pathways of disadvantage and smoking careers: evidence and policy implications. Journal of Epidemiology and Community Health. 2006;60(Suppl 2):ii7-ii12. doi:https://doi.org/10.1136/jech.2005.045583
Centers for Disease Control and Prevention. Tobacco-Related Disparities. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/disparities/index.htm. Published November 15, 2018. Accessed June 18, 2019.
North American Quitline Consortium. Quitlines and Priority Populations: An Update on Our Progress to Reach and Serve Those Most Impacted by Tobacco’s Harm.; 2016:1-13. https://c.ymcdn.com/sites/www.naquitline.org/resource/resmgr/links/QuitlinesandPriorityPopulati.pdf. Accessed April 10, 2019.
Ku L, Bruen BK, Steinmetz E, et al. Medicaid Tobacco Cessation: Big Gaps Remain In Efforts To Get Smokers To Quit. Health Affairs. 2016;35(1):62-70. doi:https://doi.org/10.1377/hlthaff.2015.0756
DiGiulio A, Haddix M, Jump Z, et al. State Medicaid Expansion Tobacco Cessation Coverage and Number of Adult Smokers Enrolled in Expansion Coverage - United States, 2016. Morbidity and Mortality Weekly Report. 2016;65(48):1364-1369. doi:https://doi.org/10.15585/mmwr.mm6548a2
Zhu S-H, Anderson CM, Zhuang Y-L, et al. Smoking prevalence in Medicaid has been declining at a negligible rate. PloS One. 2017;12(5):e0178279. doi:https://doi.org/10.1371/journal.pone.0178279
Messer K, Trinidad DR, Al-Delaimy WK, et al. Smoking Cessation Rates in the United States: A Comparison of Young Adult and Older Smokers. American Journal of Public Health. 2008;98(2):317-322. doi:https://doi.org/10.2105/AJPH.2007.112060
Kostova D, Xu X, Babb S, McMenamin SB, et al. Does State Medicaid Coverage of Smoking Cessation Treatments Affect Quitting? Health Services Research. 2018;53(6):4725-4746. doi:https://doi.org/10.1111/1475-6773.12979
Jefferis BJMH, Power C, Graham H, et al. Effects of Childhood Socioeconomic Circumstances on Persistent Smoking. American Journal of Public Health. 2004;94(2):279-285.
Prochaska JJ, Das S, Young-Wolff KC. Smoking, Mental Illness, and Public Health. Annual Review of Public Health. 2017;38:165-185. doi:https://doi.org/10.1146/annurev-publhealth-031816-044618
Zhu S-H, Anderson CM, Wong S, et al. The Growing Proportion of Smokers in Medicaid and Implications for Public Policy. American Journal of Preventive Medicine. 2018;55(6):S130-S137. doi:https://doi.org/10.1016/j.amepre.2018.07.017
Arizona Health Care Cost Containment System. AHCCCS Population Highlights June 2020. Phoenix, AZ; 2020:1. https://www.azahcccs.gov/Resources/Downloads/PopulationStatistics/2020/June/AHCCCSPopulationHighlights.pdf. Accessed June 22, 2020.
Stead LF, Hartmann-Boyce J, Perera R, Lancaster T. Telephone counselling for smoking cessation. Cochrane Database of Systematic Reviews. 2013;(8):CD002850. doi:https://doi.org/10.1002/14651858.CD002850.pub3
Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Rockville, MD: US Department of Health and Human Services; 2008.
Brady BR, Nair US, Gerald JK, et al. Higher quality quit-date goal setting enhances quit attempts among quitline callers. Tobacco Prevention and Cessation. 2019;5(June). doi:https://doi.org/10.18332/tpc/109537
Nair US, Rabe B, Brady BR, et al. Predictors of client retention in a state-based tobacco quitline. Journal of Smoking Cessation. 2020;15(2):67-75. doi:https://doi.org/10.1017/jsc.2020.10
Drope J, Liber AC, Cahn Z, et al. Who’s still smoking? Disparities in adult cigarette smoking prevalence in the United States. CA: A Cancer Journal for Clinicians. 2018;68(2):106-115. doi:https://doi.org/10.3322/caac.21444
Vangeli E, Stapleton J, Smit ES, et al. Predictors of attempts to stop smoking and their success in adult general population samples: a systematic review. Addiction. 2011;106(12):2110-2121. doi:https://doi.org/10.1111/j.1360-0443.2011.03565.x
Heatherton TF, Kozlowski LT, Frecker RC, et al. The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire. British Journal of Addiction. 1991;86(9):1119-1127.
Lent AB, O’Connor PA, Reikowsky RC, et al. Quit outcomes among clients ineligible for cessation medication through the state quitline: a retrospective, observational study. BMC Public Health. 2018;18(1):1001. doi:https://doi.org/10.1186/s12889-018-5923-6
Desquilbet L, Mariotti F. Dose-response analyses using restricted cubic spline functions in public health research. Statistics in Medicine. 2010;29(9):1037-1057. doi:https://doi.org/10.1002/sim.3841
Hosmer DW, Lemesbow S. Goodness of fit tests for the multiple logistic regression model. Communications in Statistics - Theory and Methods. 1980;9(10):1043-1069. doi:https://doi.org/10.1080/03610928008827941
Sheffer CE, Stitzer M, Landes R, et al. Socioeconomic disparities in community-based treatment of tobacco dependence. American Journal of Public Health. 2012;102(3):e8-16. doi:https://doi.org/10.2105/AJPH.2011.300519
McCarthy M, Siahpush M, Shaikh RA, et al. Social Disparities in Unaided Quit Attempts Among Daily Current and Former Smokers: Results From the 2010-2011 Tobacco Use Supplement to the Current Population Survey. Nicotine Tobacco Research. 2016;18(8):1705-1710. doi:https://doi.org/10.1093/ntr/ntw007
Babb S. Quitting Smoking Among Adults — United States, 2000–2015. Morbidity and Mortality Weekly Report. 2017;65(52):1457-1464. doi:https://doi.org/10.15585/mmwr.mm6552a1
Zhang X, Martinez-Donate AP, Kuo D, et al. Trends in home smoking bans in the USA, 1995–2007: prevalence, discrepancies and disparities. Tobacco Control. 2012;21(3):330-336. doi:https://doi.org/10.1136/tc.2011.043802
Kotz D, West R. Explaining the social gradient in smoking cessation: it’s not in the trying, but in the succeeding. Tobacco Control. 2009;18(1):43-46. doi:https://doi.org/10.1136/tc.2008.025981
Nair US, Bell ML, Yuan NP, et al. Associations Between Comorbid Health Conditions and Quit Outcomes Among Smokers Enrolled in a State Quitline, Arizona, 2011-2016. Public Health Reports. 2018;133(2):200-206. doi:https://doi.org/10.1177/0033354918764903
Hartmann-Boyce J, Chepkin SC, Ye W, et al. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database of Systematic Reviews. 2018;31(5):CD000146. doi:https://doi.org/10.1002/14651858.CD000146.pub5
Zhang L, Babb S, Schauer G, Asman K, et al. Cessation Behaviors and Treatment Use Among U.S. Smokers by Insurance Status, 2000–2015. American Journal of Preventive Medicine. 2019;57(4):478-486. doi:https://doi.org/10.1016/j.amepre.2019.06.010
Miller N, Frieden TR, Liu SY, et al. Effectiveness of a large-scale distribution programme of free nicotine patches: a prospective evaluation. The Lancet. 2005;365(9474):1849-1854. doi:https://doi.org/10.1016/S0140-6736(05)66615-9
An LC, Schillo BA, Kavanaugh AM, et al. Increased reach and effectiveness of a statewide tobacco quitline after the addition of access to free nicotine replacement therapy. Tobacco Control. 2006;15(4):286-293. doi:https://doi.org/10.1136/tc.2005.014555
Hollis JF, McAfee TA, Fellows JL, et al. The effectiveness and cost effectiveness of telephone counselling and the nicotine patch in a state tobacco quitline. Tobacco Control. 2007;16(Suppl 1):i53-i59. doi:https://doi.org/10.1136/tc.2006.019794
Jung AM, Schweers N, Bell ML, et al. Tobacco Use Cessation Among Quitline Callers Who Implemented Complete Home Smoking Bans During the Quitting Process. Preventing Chronic Disease. 2017;14. doi:https://doi.org/10.5888/pcd14.170139
Yuan NP, Nair US, Crane TE, et al. Impact of changes in home smoking bans on tobacco cessation among quitline callers. Health Education Research. 2019;34(3):345-355. doi:https://doi.org/10.1093/her/cyz008
American Academy of Addiction Psychiatry. Nicotine Dependence. 2015:1-4. http://www.aaap.org/wp-content/uploads/2015/06/AAAP-nicotine-dependence-FINAL.pdf. Accessed February 15, 2021.
Fu SS, van Ryn M, Nelson D, et al. Proactive tobacco treatment offering free nicotine replacement therapy and telephone counselling for socioeconomically disadvantaged smokers: a randomised clinical trial. Thorax. 2016;71(5):446-453. doi:https://doi.org/10.1136/thoraxjnl-2015-207904
North American Quitline Consortium. Measuring Quit Rates. Quality Improvement Initiative. Phoenix, AZ: North American Quitline Consortium; 2009:1-32. http://c.ymcdn.com/sites/www.naquitline.org/resource/resmgr/docs/naqc_issuepaper_measuringqui.pdf. Accessed November 18, 2016.
Hays JT, Leischow SJ, Lawrence D, et al. Adherence to treatment for tobacco dependence: Association with smoking abstinence and predictors of adherence. Nicotine Tobacco Research. 2010;12(6):574-581. doi:https://doi.org/10.1093/ntr/ntq047
Handschin J, Hitsman B, Blazekovic S, et al. Factors Associated with Adherence to Transdermal Nicotine Patches within a Smoking Cessation Effectiveness Trial. Journal of Smoking Cessation. 2018;13(1):33-43. doi:https://doi.org/10.1017/jsc.2017.2
Funding
This research was supported by Arizona Department of Health Services Grants ADHS11-007339, ADHS16-106672, and ADHS13-026130:5. Services and products in support of the research project were generated by the University of Arizona Cancer Center Behavioral Measurement and Interventions Shared Resource, supported, in part, with funding from NIH-NCI Cancer Center Support Grant P30 CA023074. This research was supported by Arizona Department of Health Services and Arizona Smokers’ Helpline. The University of Arizona’s Institutional Review Board reviewed the study protocol and deemed it exempt. All authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare no competing interests.
Disclaimer
The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies or the University of Arizona.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Brady, B.R., O’Connor, P.A., Martz, M.P. et al. Medicaid-Insured Client Characteristics and Quit Outcomes at the Arizona Smokers’ Helpline. J Behav Health Serv Res 49, 61–75 (2022). https://doi.org/10.1007/s11414-021-09756-2
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11414-021-09756-2