Smoking prevalence in Medicaid has been declining at a negligible rate

Abstract

BackgroundIn recent decades the overall smoking prevalence in the US has fallen steadily. This study examines whether the same trend is seen in the Medicaid population.Methods and findingsNational Health Interview Survey (NHIS) data from 17 consecutive annual surveys from 1997 to 2013 (combined N = 514,043) were used to compare smoking trends for 4 insurance groups: Medicaid, the Uninsured, Private Insurance, and Other Coverage. Rates of chronic disease and psychological distress were also compared.ResultsAdjusted smoking prevalence showed no detectable decline in the Medicaid population (from 33.8% in 1997 to 31.8% in 2013, trend test P = 0.13), while prevalence in the other insurance groups showed significant declines (38.6%-34.7% for the Uninsured, 21.3%-15.8% for Private Insurance, and 22.6%-16.8% for Other Coverage; all P’s<0.005). Among individuals who have ever smoked, Medicaid recipients were less likely to have quit (38.8%) than those in Private Insurance (62.3%) or Other Coverage (69.8%; both P’s<0.001). Smokers in Medicaid were more likely than those in Private Insurance and the Uninsured to have chronic disease (55.0% vs 37.3% and 32.4%, respectively; both P’s<0.01). Smokers in Medicaid were also more likely to experience severe psychological distress (16.2% for Medicaid vs 3.2% for Private Insurance and 7.6% for the Uninsured; both P’s<0.001).ConclusionsThe high and relatively unchanging smoking prevalence in the Medicaid population, low quit ratio, and high rates of chronic disease and severe psychological distress highlight the need to focus on this population. A targeted and sustained campaign to help Medicaid recipients quit smoking is urgently needed.

Racial/Ethnic Differences in the Response to Incentives for Quitline Engagement

“…Medi-Cal callers in the MIQS program had a similar demographic profile to the national Medicaid population in 2013. 3 However, they were distinct from the national population in that among the California Medi-Cal smoker population, 50% were Latinx. 4 The breadth and reach of the statewide outreach efforts to the African American population to local programs, like the Black Infant Health, in the early phase of the MIQS program was likely one of the primary reasons why percentages of asking for the $20 incentive peaked during this time and remained above all other groups.…”

“…1,2 Medicaid beneficiaries who are smokers are less likely to quit smoking, and have a higher prevalence of comorbid medical and psychiatric illness. 3,4 Smoking contributes to more than 15% of the Medicaid costs, estimated at more than $75 billion in 2016 with the expansion of the Medicaid population under the Affordable Care Act. 5 About two thirds of California's Medicaid (i.e., Medi-Cal) population is comprised of racial/ethnic minority groups.…”

Advancing Smoking Cessation in California's Medicaid Population

“…Given that California's Medicaid population is larger than the population of many states, having the opportunity to examine the impact and cost effectiveness of a health promotion intervention in this population is important and noteworthy as Medicaid enrollees are more likely to report having a chronic disease and high rates of psychological distress. 15,16 As such, interventions to motivate and sustain enrollment of this population in health promotion activities are likely to require greater intensity than for the general population. Determining what will accelerate health improvements among Medi-Cal members and then designing and transforming the healthcare system to offer tailored and effective interventions is at the crux of health equity and DHCS's Quality Strategy.…”

“…15 Remarkably, nationally and in California, quit attempt rates among smokers with Medicaid insurance are comparable to those with private insurance, yet this population is less successful at quitting, and smoking rates among Medicaid beneficiaries remain stagnant. 15,16 ABOUT THE MEDI-CAL INCENTIVES TO QUIT SMOKING PROJECT…”

Geographical differences in semen characteristics: Comparing semen parameters of infertile men of the United States and Iraq

“…The results obtained in this study regarding the smoking behaviour in the United States are inconsistent with previous reports (Caserta et al, 2013;Sharma, Harlev, Agarwal, & Esteves, 2016;Zhang et al., 2013) and are most probably due to the small sample size. Therefore, further larger-scaled studies are necessary focusing particularly on the influence of smoking upon semen parameters in different populations (Zhu, Anderson, Zhuang, Gamst, & Kohatsu, 2017) and thereby level out this obvious confounding factor.…”