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Association of Medicaid Expansion and Health Insurance with Receipt of Smoking Cessation Services and Smoking Behaviors in Substance Use Disorder Treatment

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Abstract

This study examined whether living in a Medicaid-expanded state or having health insurance was associated with receipt of smoking cessation services or smoking behaviors among substance use disorder (SUD) treatment clients. In 2015 and 2016, 1702 SUD clients in 14 states were surveyed for health insurance status, smoking cessation services received in their treatment program, and smoking behaviors. Services and behaviors were then compared by state Medicaid expansion and health insurance status independently. Clients in Medicaid-expanded states were more likely to be insured (89.9% vs. 54.4%, p < 0.001) and to have quit smoking during treatment (AOR = 3.77, 95% CI = 2.47, 5.76). Insured clients had higher odds of being screened for smoking status in their treatment program and making quit attempts in the past year. Medicaid expansion supports greater health insurance coverage of individuals in SUD treatment and may enhance smoking cessation.

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References

  1. Saloner B, Levin J, Chang H-Y, et al. Changes in buprenorphine-naloxone and opioid pain reliever prescriptions after the Affordable Care Act Medicaid expansion. JAMA Network Open. 2018;1(4):e181588-e181588.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Meinhofer A, Witman AE. The role of health insurance on treatment for opioid use disorders: Evidence from the Affordable Care Act Medicaid expansion. Journal of Health Economics. 2018;60:177–197.

    Article  PubMed  Google Scholar 

  3. Guydish J, Tajima B, Pramod S, et al. Use of multiple tobacco products in a national sample of persons enrolled in addiction treatment. Drug and Alcohol Dependence. 2016;166:93–99.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bandiera FC, Anteneh B, Le T, et al. Tobacco-related mortality among persons with mental health and substance abuse problems. Plos One. 2015;10(3):e0120581.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  5. Hser YI, McCarthy WJ, Anglin MD. Tobacco use as a distal predictor of mortality among long-term narcotics addicts. Preventive Medicine. 1994;23(1):61–69.

    Article  CAS  PubMed  Google Scholar 

  6. Hurt RD, Offord KP, Croghan IT, et al. Mortality following inpatient addictions treatment. Role of tobacco use in a community-based cohort. The Journal of the American Medical Association. 1996;275(14):1097–1103.

    Article  CAS  PubMed  Google Scholar 

  7. Weinberger AH, Platt J, Esan H, et al. Cigarette Smoking Is Associated With Increased Risk of Substance Use Disorder Relapse: A Nationally Representative, Prospective Longitudinal Investigation. Journal of Clinical Psychiatry. 2017;78(2):E152-E160.

    Article  PubMed  Google Scholar 

  8. McKelvey K, Thrul J, Ramo D. Impact of quitting smoking and smoking cessation treatment on substance use outcomes: An updated and narrative review. Addictive Behaviors. 2017;65:161–170.

    Article  PubMed  Google Scholar 

  9. Tsoh JY, Chi FW, Mertens JR, et al. Stopping smoking during first year of substance use treatment predicted 9-year alcohol and drug treatment outcomes. Drug and Alcohol Dependence. 2011;114(2–3):110–118.

    PubMed  Google Scholar 

  10. Medicaid.gov. Medicaid Eligibility. 2018; https://www.medicaid.gov/medicaid/eligibility/. Accessed December 12, 2018.

  11. Harwood JM, Azocar F, Thalmayer A, et al. The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral healthcare utilization and spending among carve-in enrollees. Medical Care. 2017;55(2):164.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Abraham AJ, Andrews CM, Grogan CM, et al. The Affordable Care Act Transformation of Substance Use Disorder Treatment. American Journal of Public Health. 2017;107(1):31–32.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kaiser Family Foundation. Current Status of State Medicaid Expansion Decisions. 2018; https://www.kff.org/health-reform/slide/current-status-of-the-medicaid-expansion-decision/. Accessed December 12, 2018.

  14. Garrett AB, Gangopadhyaya A. Who Gained Health Insurance Coverage Under the ACA, and Where Do They Live? 2016; https://www.urban.org/sites/default/files/publication/86761/2001041-who-gained-health-insurance-coverage-under-the-aca-and-where-do-they-live.pdf. Accessed December 12, 2018.

  15. McMenamin SB, Yoeun SW, Halpin HA. Affordable Care Act Impact on Medicaid Coverage of Smoking-Cessation Treatments. American Journal of Preventive Medicine. 2018;54(4):479–485.

    Article  PubMed  Google Scholar 

  16. 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.

    Article  PubMed  Google Scholar 

  17. Fox JB, Shaw FE, Office of Health System Collaboration OotADfPCDC. Relationship of income and health care coverage to receipt of recommended clinical preventive services by adults - United States, 2011-2012. Morbidity and Mortality Weekly Report. 2014;63(31):666–670.

    PubMed  PubMed Central  Google Scholar 

  18. Babb S, Malarcher A, Schauer G, et al. Quitting Smoking Among Adults - United States, 2000-2015. Morbidity and Mortality Weekly Report. 2017;65(52):1457–1464.

    Article  PubMed  Google Scholar 

  19. Bailey SR, Hoopes MJ, Marino M, et al. Effect of Gaining Insurance Coverage on Smoking Cessation in Community Health Centers: A Cohort Study. Journal of General Internal Medicine. 2016;31(10):1198–1205.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Naavaal S, Malarcher A, Xu X, et al. Variations in Cigarette Smoking and Quit Attempts by Health Insurance Among US Adults in 41 States and 2 Jurisdictions, 2014. Public Health Reports. 2018;133(2):191–199.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Greene J, Sacks RM, McMenamin SB. The Impact of Tobacco Dependence Treatment Coverage and Copayments in Medicaid. American Journal of Preventive Medicine. 2014;46(4):331–336.

    Article  PubMed  Google Scholar 

  22. Land T, Warner D, Paskowsky M, et al. Medicaid coverage for tobacco dependence treatments in Massachusetts and associated decreases in smoking prevalence. Plos One. 2010;5(3):e9770.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Knudsen HK. Implementation of smoking cessation treatment in substance use disorder treatment settings: a review. The American Journal of Drug and Alcohol Abuse. 2017;43(2):215–225.

    Article  PubMed  Google Scholar 

  24. Campbell BK, Le T, Tajima B, et al. Quitting smoking during substance use disorders treatment: Patient and treatment-related variables. Journal of Substance Abuse Treatment. 2017;73:40–46.

    Article  PubMed  Google Scholar 

  25. Cohn A, Elmasry H, Niaura R. Facility-level, state, and financial factors associated with changes in the provision of smoking cessation services in US substance abuse treatment facilities: Results from the National Survey of Substance Abuse Treatment Services 2006 to 2012. Journal of Substance Abuse Treatment. 2017;77:107–114.

    Article  PubMed  Google Scholar 

  26. Knudsen HK, Roman PM. Medicaid, Private Insurance, and the Availability of Smoking Cessation Interventions in Substance Use Disorder Treatment. Psychiatric Services. 2015;66(11):1213–1220.

    Article  PubMed  Google Scholar 

  27. Gerstein DR, Lewin LS. Treating drug problems. N Engl J Med. 1990;323(12):844–848.

    Article  CAS  PubMed  Google Scholar 

  28. Pagano A, Tajima B, Guydish J. Barriers and Facilitators to Tobacco Cessation in a Nationwide Sample of Addiction Treatment Programs. Journal of Substance Abuse Treatment. 2016;67:22–29.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Guydish J, Yip D, Le T, et al. Smoking-related outcomes and associations with tobacco-free policy in addiction treatment, 2015-2016. Drug and Alcohol Dependence. 2017;179:355–361.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Centers for Disease Control and Prevention. National Health Interview Survey Glossary. 2017; https://www.cdc.gov/nchs/nhis/tobacco/tobacco_glossary.htm. Accessed December 12, 2018.

  31. Klemperer EM, Hughes JR, Naud S. Reduction in Cigarettes per Day Prospectively Predicts Making a Quit Attempt: A Fine-Grained Secondary Analysis of a Natural History Study. Nicotine and Tobacco Research. 2019;21(5):648–654.

    Article  PubMed  Google Scholar 

  32. Kaiser Family Foundation. The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review. 2018; https://www.kff.org/medicaid/issue-brief/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review-march-2018/. Accessed December 12, 2018.

  33. Koma JW, Donohue JM, Barry CL, et al. Medicaid Coverage Expansions and Cigarette Smoking Cessation Among Low-income Adults. Medical Care. 2017;55(12):1023–1029.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Brantley E, Greene J, Bruen B, et al. Policies Affecting Medicaid Beneficiaries’ Smoking Cessation Behaviors. Nicotine and Tobacco Research. 2018.

    Google Scholar 

  35. Simon K, Soni A, Cawley J. The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions. Journal of Policy Analysis and Management. 2017;36(2):390–417.

    Article  PubMed  Google Scholar 

  36. Sommers BD, Blendon RJ, Orav EJ, et al. Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance. JAMA Internal Medicine. 2016;176(10):1501–1509.

    Article  PubMed  Google Scholar 

  37. Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs—2014. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014.

    Google Scholar 

  38. US Department of Health and Human Services. The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health;2014.

    Google Scholar 

  39. Ziedonis DM, Guydish J, Williams J, et al. Barriers and solutions to addressing tobacco dependence in addiction treatment programs. Alcohol Research & Health. 2006;29(3):228–235.

    Google Scholar 

  40. Knudsen HK, Studts JL, Boyd S, et al. Structural and cultural barriers to the adoption of smoking cessation services in addiction treatment organizations. Journal of Addictive Diseases. 2010;29(3):294–305.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Brown CC, Tilford JM, Bird TM. Improved Health and Insurance Status Among Cigarette Smokers After Medicaid Expansion, 2011-2016. Public Health Reports. 2018;133(3):294–302.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Guydish J, Passalacqua E, Tajima B, et al. Staff smoking and other barriers to nicotine dependence intervention in addiction treatment settings: a review. Journal of Psychoactive Drugs. 2007;39(4):423–433.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Knox B, Mitchell S, Hernly E, et al. Barriers to Utilizing Medicaid Smoking Cessation Benefits. Kansas Journal of Medicine. 2017;10(4):1–11.

    PubMed  Google Scholar 

  44. Tong VT, England LJ, Malarcher A, et al. Clinicians’ awareness of the Affordable Care Act mandate to provide comprehensive tobacco cessation treatment for pregnant women covered by Medicaid. Preventive Medicine Reports. 2015;2:686–688.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Chaiton MO, Cohen JE, McDonald PW, et al. The Heaviness of Smoking Index as a predictor of smoking cessation in Canada. Addictive Behaviors. 2007;32(5):1031–1042.

    Article  PubMed  Google Scholar 

  46. Susukida R, Crum RM, Stuart EA, et al. Assessing sample representativeness in randomized controlled trials: application to the National Institute of Drug Abuse Clinical Trials Network. Addiction. 2016;111(7):1226–1234.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

The authors gratefully acknowledge the support of directors who agreed that their program could participate in the study, the program staff who coordinated site visits and data collection, and the clients who gave their time to complete study surveys.

Funding

This work was supported by grant number R01 DA036066 from the National Institute on Drug Abuse (NIDA) and the Food and Drug Administration Center for Tobacco Products and by NIDA Center Grant P50 DA009253.

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Authors and Affiliations

  1. Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St., Ste. 265, San Francisco, CA, 94118, USA

    Deborah Yip BA, Noah Gubner PhD, Thao Le MPH, Denise Williams MA & Joseph Guydish PhD

  2. Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave., San Francisco, CA, 94143, USA

    Kevin Delucchi PhD

Authors
  1. Deborah Yip BA
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  2. Noah Gubner PhD
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Corresponding author

Correspondence to Deborah Yip BA.

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Study procedures were approved by the University of California, San Francisco, Institutional Review Board.

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The authors declare that they have no conflicts of interest.

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Yip, D., Gubner, N., Le, T. et al. Association of Medicaid Expansion and Health Insurance with Receipt of Smoking Cessation Services and Smoking Behaviors in Substance Use Disorder Treatment. J Behav Health Serv Res 47, 264–274 (2020). https://doi.org/10.1007/s11414-019-09669-1

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  • DOI: https://doi.org/10.1007/s11414-019-09669-1

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