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Nonnemaker J, Mann N, MacMonegle AJ, Gaber J, Fajobi O. Estimating the return on investment of the New York Tobacco Control Programme: a synthetic control study. BMJ Open 2024; 14:e080525. [PMID: 38569704 PMCID: PMC10989166 DOI: 10.1136/bmjopen-2023-080525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/08/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE To assess the return on investment (ROI) of the New York Tobacco Control Programme (NY TCP). SETTING New York and other states of the USA. INTERVENTIONS NY TCP. OUTCOMES Smoking prevalence, smoking-attributable healthcare expenditures (SAEs), smoking-attributable mortality, years of life lost (YLL), the dollar value of YLL and the ROI for healthcare expenditures and mortality. DESIGN AND METHODS We used a synthetic control method to estimate the effectiveness of NY TCP funding on smoking prevalence. The synthetic control method created a comparison group that best matched the adult smoking prevalence trend in New York state in the period prior to implementation of the NY TCP and compared smoking prevalence in the state to smoking prevalence in the synthetic control in the period after treatment (2001-2019). The synthetic control group represents what the trend in smoking prevalence in New York would have been had there been no tobacco control expenditures. The ROI was calculated as net savings for each outcome divided by net programme expenditures. RESULTS Cumulative savings in SAE in New York from 2001 to 2019 amounted to US$13.2 billion. An estimated 41 771 smoking-attributable deaths (SADs) were averted in New York from 2001 to 2019, and an estimated 672 141 YLL averted as a result of NY TCP funding in the same period. From 2001 to 2019, the ROI for SAE in New York was approximately 14, the economic value ROI of the YLL due to SAD was nearly 145 and the combined ROI was almost 160. CONCLUSIONS In this study, we found relatively large ROIs for the NY TCP, which suggests that the programme-which lowers SAE and saves lives-is an efficient use of public funds.
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Affiliation(s)
| | - Nathan Mann
- RTI International, Research Triangle Park, North Carolina, USA
| | | | - Jennifer Gaber
- RTI International, Research Triangle Park, North Carolina, USA
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Flores MW, Mullin B, Sharp A, Kumar A, Moyer M, Cook BL. Examining Racial/Ethnic Disparities in Tobacco Dependence Treatment Among Medicaid Beneficiaries Using Fifty State Medicaid Claims, 2009-2014. J Racial Ethn Health Disparities 2024; 11:755-763. [PMID: 37326794 DOI: 10.1007/s40615-023-01558-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 06/17/2023]
Abstract
In the USA, low-income racial/ethnic minority groups experience higher smoking rates and greater smoking-related disease burden than their White counterparts. Despite the adverse effects, racial/ethnic minorities are less likely to access tobacco dependence treatment (TDT). Medicaid is one of the largest payers of TDT in the USA and covers predominantly low-income populations. The extent of TDT use among beneficiaries from distinct racial/ethnic groups is unknown. The objective is to estimate racial/ethnic differences in TDT use among Medicaid fee-for-service beneficiaries. Using a retrospective study design and 50 state (including the District of Columbia) Medicaid claims (2009-2014), we employed multivariable logistic regression models and predictive margin methods to estimate TDT use rates among adults (18-64) enrolled (≥ 11 months) in Medicaid fee-for-service programs (January 2009-December 2014) by race/ethnicity. The population included White (n = 6,536,004), Black (n = 3,352,983), Latinx (n = 2,264,647), Asian (n = 451,448), and Native American/Alaskan Native (n = 206,472) beneficiaries. Dichotomous outcomes reflected service use in the past year. Any TDT use was operationalized as any smoking cessation medication fill, any smoking cessation counseling visit, or any smoking cessation outpatient visit. In secondary analyses, we disaggregated TDT use into three separate outcomes. Results suggested that Black (10.6%; 95% CI = 9.9-11.4%), Latinx (9.5%; 95% CI = 8.9-10.2%), Asian (3.7%; 95% CI = 3.4-4.1%), and Native American/Alaskan Native (13.7%; 95% CI = 12.7-14.7%) beneficiaries had lower TDT use rates compared to White beneficiaries (20.6%). Similar racial/ethnic treatment disparities were identified across all outcomes. By identifying significant racial/ethnic disparities in TDT use between 2009 and 2014, this study provides a benchmark against which to measure recent interventions in state Medicaid programs improving equity in smoking cessation interventions.
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Affiliation(s)
- Michael William Flores
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Brian Mullin
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA
| | - Amanda Sharp
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA
- Center for Mindfulness & Compassion, Cambridge Health Alliance, Cambridge, MA, USA
| | - Anika Kumar
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA
- Heller School of Social Policy, Brandies University, Waltham, MA, USA
| | - Margo Moyer
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA
| | - Benjamin Lê Cook
- Health Equity Research Lab, Cambridge Health Alliance, 1035 Cambridge St., Suite 26, Cambridge, MA, 02141, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Mundt MP, McCarthy DE, Baker TB, Zehner ME, Zwaga D, Fiore MC. Cost-Effectiveness of a Comprehensive Primary Care Smoking Treatment Program. Am J Prev Med 2024; 66:435-443. [PMID: 37844710 PMCID: PMC10922402 DOI: 10.1016/j.amepre.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Smoking is the leading preventable cause of death and disease in the U.S. This study evaluates the cost-effectiveness from a healthcare system perspective of a comprehensive primary care intervention to reduce smoking rates. METHODS This pragmatic trial implemented electronic health record prompts during primary care visits and employed certified tobacco cessation specialists to offer proactive outreach and smoking cessation treatment to patients who smoke. The data, analyzed in 2022, included 10,683 patients in the smoking registry from 2017 to 2020. Pre-post analyses compared intervention costs to treatment engagement, successful self-reported smoking cessation, and acute health care utilization (urgent care, emergency department visits, and inpatient hospitalization). Cost per quality-adjusted life year was determined by applying conversion factors obtained from the tobacco research literature to the cost per patient who quit smoking. RESULTS Tobacco cessation outreach, medication, and counseling costs increased from $2.64 to $6.44 per patient per month, for a total post-implementation intervention cost of $500,216. Smoking cessation rates increased from 1.3% pre-implementation to 8.7% post-implementation, for an incremental effectiveness of 7.4%. The incremental cost-effectiveness ratio was $628 (95% CI: $568, $695) per person who quit smoking, and $905 (95% CI: $822, $1,001) per quality-adjusted life year gained. Acute health care costs decreased by an average of $42 (95% CI: -$59, $145) per patient per month for patients in the smoking registry. CONCLUSIONS Implementation of a comprehensive and proactive smoking cessation outreach and treatment program for adult primary care patients who smoke meets typical cost-effectiveness thresholds for healthcare.
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Affiliation(s)
- Marlon P Mundt
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.
| | - Danielle E McCarthy
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin; Department of Medicine, Division of General Internal Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Timothy B Baker
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin; Department of Medicine, Division of General Internal Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Mark E Zehner
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Deejay Zwaga
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Michael C Fiore
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin; Department of Medicine, Division of General Internal Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
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Herbst RS, Hatsukami D, Acton D, Giuliani M, Moushey A, Phillips J, Sherwood S, Toll BA, Viswanath K, Warren NJH, Warren GW, Alberg AJ. Electronic Nicotine Delivery Systems: An Updated Policy Statement From the American Association for Cancer Research and the American Society of Clinical Oncology. J Clin Oncol 2022; 40:4144-4155. [PMID: 36287017 DOI: 10.1200/jco.22.01749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Combustible tobacco use has reached historic lows, demonstrating the importance of proven strategies to reduce smoking since publication of the 1964 Surgeon General's report. In contrast, the use of electronic nicotine delivery systems (ENDS), specifically e-cigarettes, has grown to alarming rates and threatens to hinder progress against tobacco use. A major concern is ENDS use by youth and adults who never previously used tobacco. While ENDS emit fewer carcinogens than combustible tobacco, preliminary evidence links ENDS use to DNA damage and inflammation, key steps in cancer development. Furthermore, high levels of nicotine can also increase addiction, raise blood pressure, interfere with brain development, and suppress the immune system. The magnitude of long-term health risks will remain unknown until longitudinal studies are completed. ENDS have been billed as a promising tool for combustible tobacco cessation, but further evidence is needed to assess their potential efficacy for adults who smoke. Of concern, epidemiological studies estimate that approximately 15%-42% of adults who use ENDS have never used another tobacco product, and another 36%-54% dual use both ENDS and combustible tobacco. This policy statement details advances in science related to ENDS and calls for urgent action to end predatory practices of the tobacco industry and protect public health. Importantly, we call for an immediate ban on all non-tobacco-flavored ENDS products that contain natural or synthetic nicotine to reduce ENDS use by youth and adults who never previously used tobacco. Concurrently, evidence-based treatments to promote smoking cessation and prevent smoking relapse to reduce cancer incidence and improve public health remain top priorities for our organizations. We also recognize there is an urgent need for research to understand the relationship between ENDS and tobacco-related disparities.
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Affiliation(s)
- Roy S Herbst
- Yale Comprehensive Cancer Center, Yale School of Medicine, New Haven, CT
| | | | - Dana Acton
- American Association for Cancer Research, Washington, DC
| | | | - Allyn Moushey
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | | | | | | | | | - Anthony J Alberg
- Arnold School of Public Health, University of South Carolina, Columbia, SC
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Herbst RS, Hatsukami D, Acton D, Giuliani M, Moushey A, Phillips J, Sherwood S, Toll BA, Viswanath K, Warren NJH, Warren GW, Alberg AJ. Electronic Nicotine Delivery Systems: An Updated Policy Statement from the American Association for Cancer Research and the American Society of Clinical Oncology. Clin Cancer Res 2022; 28:4861-4870. [PMID: 36287033 DOI: 10.1158/1078-0432.ccr-22-2429] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/01/2022] [Indexed: 01/24/2023]
Abstract
Combustible tobacco use has reached historic lows, demonstrating the importance of proven strategies to reduce smoking since publication of the 1964 Surgeon General's report. In contrast, the use of electronic nicotine delivery systems (ENDS), specifically e-cigarettes, has grown to alarming rates and threatens to hinder progress against tobacco use. A major concern is ENDS use by youth and adults who never previously used tobacco. While ENDS emit fewer carcinogens than combustible tobacco, preliminary evidence links ENDS use to DNA damage and inflammation, key steps in cancer development. Furthermore, high levels of nicotine can also increase addiction, raise blood pressure, interfere with brain development, and suppress the immune system. The magnitude of long-term health risks will remain unknown until longitudinal studies are completed. ENDS have been billed as a promising tool for combustible tobacco cessation, but further evidence is needed to assess their potential efficacy for adults who smoke. Of concern, epidemiological studies estimate that approximately 15% to 42% of adults who use ENDS have never used another tobacco product, and another 36% to 54% "dual use" both ENDS and combustible tobacco. This policy statement details advances in science related to ENDS and calls for urgent action to end predatory practices of the tobacco industry and protect public health. Importantly, we call for an immediate ban on all non-tobacco-flavored ENDS products that contain natural or synthetic nicotine to reduce ENDS use by youth and adults who never previously used tobacco. Concurrently, evidence-based treatments to promote smoking cessation and prevent smoking relapse to reduce cancer incidence and improve public health remain top priorities for our organizations. We also recognize there is an urgent need for research to understand the relationship between ENDS and tobacco-related disparities.
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Affiliation(s)
- Roy S Herbst
- Yale Comprehensive Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | | | - Dana Acton
- American Association for Cancer Research, Washington, D.C
| | | | - Allyn Moushey
- American Society of Clinical Oncology, Alexandria, Virginia
| | | | | | - Benjamin A Toll
- Medical University of South Carolina, Charleston, South Carolina
| | | | | | - Graham W Warren
- Medical University of South Carolina, Charleston, South Carolina
| | - Anthony J Alberg
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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McBrayer K, Ouyang F, Adams Z, Hulvershorn L, Aalsma MC. Rates of Tobacco Use Disorder, Pharmacologic Treatment, and Associated Mental Health Disorders in a Medicaid Claim Review Among Youth in Indiana, USA. Tob Use Insights 2022; 15:1179173X221119133. [PMID: 36052177 PMCID: PMC9424880 DOI: 10.1177/1179173x221119133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose This study delineates a number of Medicaid youth with tobacco use disorder (TUD), prescribing habits for treatment, and associated externalizing disorders. Methods Youth Medicaid claims from 2007-2017 processed in a large Midwestern city were analyzed for a diagnosis of TUD, related pharmacotherapy, and externalizing mental health and substance use disorders. Results Claims connected 6541 patients with 42 890 visits. Mean age was 16.4 with 40% female. 1232 of the 6541 charts contained a TUD diagnosis equating to 1848 visits. A comorbid diagnosis of ADHD, cannabis use, and conduct disorder were more common in males (3.9% vs 1.3% in females; 3.4% vs .8%; and 2.8% vs .8%; P < .05). 808 scripts were provided to 152 of the 1232 youths, with 4.7% of those scripts a nicotine replacement product. Conclusions Pharmacotherapy is underutilized in this Medicaid claims data set. Certain externalizing factors were associated with males with TUD more than females.
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Affiliation(s)
- Kimberly McBrayer
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Fangqian Ouyang
- Department of Biostatistics, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Zachary Adams
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Leslie Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Matthew C Aalsma
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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Jackson SL, Tsipas S, Yang PK, Ritchey MD, Loustalot F, Wozniak G, Wang X. Prescription Smoking-Cessation Medication Fills and Spending, 2009-2019. Am J Prev Med 2022; 62:e351-e355. [PMID: 35597571 PMCID: PMC9186091 DOI: 10.1016/j.amepre.2021.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/19/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Smoking is the leading cause of preventable disease and death. However, effective medicines, including prescription medications often covered by health insurance, are available to aid cessation. METHODS Trends of 7 U.S. Food and Drug Administration-approved prescription medications for smoking cessation during 2009-2019 (before and during Affordable Care Act implementation), including fill counts and spending (total and patient, adjusted to 2019 U.S. dollars), were assessed among U.S. adults aged ≥18 years. Symphony Health's Integrated Dataverse combines data on >90% of outpatient prescription fills with market purchasing data to create national estimates. Analyses were conducted in 2021. RESULTS Annually, total fills (spending) decreased from 3.7 million ($577 million) in 2009 to 2.5 million ($465 million) in 2013 and increased to 4.5 million ($1.279 billion) in 2019; patient spending decreased from $174 million (30% of total annual spending) in 2009 to $54 million (4%) in 2019. Comparing 2009 with 2019, the total spending per fill increased by 80% (from $157 to $282), whereas patient spending per fill decreased by 75% (from $47 to $12). The total spending per fill for branded products increased by 175% (from $166 to $459) and decreased by 41% (from $75 to $44) for generic products. Branded product percentage decreased from 89% to 57%. CONCLUSIONS Total fills and spending decreased from 2009 to 2013 and then increased through 2019, whereas patient spending decreased. Earlier studies suggest possible reasons for these trends, such as gradual implementation of federal requirements for insurance coverage of cessation medications and reduced cost sharing and financial barriers.
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Affiliation(s)
- Sandra L Jackson
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | | | - Peter K Yang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew D Ritchey
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fleetwood Loustalot
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Xu Wang
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Eakin MN, Bauer SE, Carr T, Dagli E, Ewart G, Garfield JL, Jaspers I, Kher S, Leone FT, Melzer AC, Moazed F, Moraes TJ, Reddy KP, Upson D, Kathuria H. Policy Recommendations to Eliminate Tobacco Use and Improve Health from the American Thoracic Society Tobacco Action Committee. Ann Am Thorac Soc 2022; 19:157-160. [PMID: 34347555 PMCID: PMC10285748 DOI: 10.1513/annalsats.202104-493ps] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/03/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Michelle N. Eakin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Sarah E. Bauer
- Section of Pediatric Pulmonology, Allergy, and Sleep Medicine, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
| | - Thomas Carr
- American Lung Association, Chicago, Illinois
| | - Elif Dagli
- Marmara University, Health Institute Association, Istanbul, Turkey
| | - Gary Ewart
- American Thoracic Society, Washington, DC
| | - Jamie L. Garfield
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Ilona Jaspers
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sucharita Kher
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts
| | - Frank T. Leone
- Comprehensive Smoking Treatment Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anne C. Melzer
- Section of Pulmonary, Allergy, Critical Care and Sleep, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Farzad Moazed
- Division of Pulmonary and Critical Care Medicine, Alameda Health System, Oakland, California
| | - Theo J. Moraes
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Krishna P. Reddy
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Dona Upson
- Pulmonary, Critical Care and Sleep Medicine, New Mexico Veterans Affairs Health Care System, Albuquerque, New Mexico; and
| | - Hasmeena Kathuria
- The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
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Medicaid coverage for tobacco dependence treatment: Enrollee awareness and use. Prev Med Rep 2021; 24:101509. [PMID: 34430191 PMCID: PMC8368993 DOI: 10.1016/j.pmedr.2021.101509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/16/2021] [Accepted: 07/28/2021] [Indexed: 11/23/2022] Open
Abstract
Medicaid-insured adults smoke at twice the rate of privately insured adults. Insurance coverage for tobacco dependence treatments (TDTs) has been shown to increase quit attempts, but few published studies have measured enrollees’ awareness of Medicaid coverage. We assessed awareness of Medicaid coverage for and use of TDTs among New York State (NYS) Medicaid-insured smokers and recent quitters. In July-August 2017, we conducted a probability-based online survey of Medicaid enrollees in NYS aged 18 to 65 in fee-for-service and managed care plans (n = 266; AAPOR 4RR = 22.5%). In 2017, we estimated descriptive statistics and used Adjusted Wald tests to assess differences in awareness and use of TDTs (p < 0.05). We used logistic regression to assess correlates of coverage awareness and use of TDTs. Most participants (94.3%) were aware of TDTs, but fewer were aware that Medicaid covers them (59.7%). Most participants believed TDTs are effective in helping smokers quit, although many also believed non-evidence-based methods are effective. Awareness of Medicaid coverage was associated with awareness of a Medicaid-related antitobacco television ad (p < 0.05), moderate nicotine dependence (p < 0.05), and believing that TDTs are effective (p < 0.01). Although awareness of Medicaid coverage for TDTs was found to be high, there remains room for improvement, even in a state that actively promotes these benefits. It is important for states to not only expand Medicaid coverage of TDTs but to also promote the benefits to improve the chances of quit success. Understanding Medicaid enrollees’ awareness of and perceptions of covered TDTs can inform messaging to maximize utilization of evidence-based benefits.
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Hilts KE, Blackburn J, Gibson PJ, Yeager VA, Halverson PK, Menachemi N. Impact of Medicaid expansion on smoking prevalence and quit attempts among those newly eligible, 2011-2019. Tob Prev Cessat 2021; 7:16. [PMID: 34414341 PMCID: PMC8336658 DOI: 10.18332/tpc/139812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/24/2021] [Accepted: 07/03/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Low-income populations have higher rates of smoking and are disproportionately affected by smoking-related illnesses. This study assessed the long-term impact of increased coverage for tobacco cessation through Medicaid expansion on past-year quit attempts and prevalence of cigarette smoking. METHODS Using data from CDC's annual Behavioral Risk Factor Surveillance System 2011-2019, we conducted difference-in-difference regression analyses to compare changes in smoking prevalence and past-year quit attempts in expansion states versus non-expansion states. Our sample included non-pregnant adults (18-64 years old) without dependent children with incomes at or below 100% of the Federal Poverty Level (FPL). RESULTS Regression analyses indicate that Medicaid expansion was associated with reduced smoking prevalence in the first two years post-expansion (β=-0.019, p=0.04), but that this effect was not maintained at longer follow-up periods (β=-0.006, p=0.49). Results of regression analyses also suggest that Medicaid expansion does not significantly impact quit attempts in the short-term (β=-0.013, p=0.52) or at longer term follow-up (β=-0.026, p=0.08). CONCLUSIONS Expanded coverage for tobacco cessation services through Medicaid alone may not be enough to increase quit-attempts or sustain a reduction in overall prevalence of smoking in newly eligible populations over time. Medicaid programs should consider additional strategies, such as public education campaigns and removal of barriers, to support cessation among enrollees.
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Affiliation(s)
- Katy Ellis Hilts
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, United States
| | - Justin Blackburn
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, United States
| | - P Joseph Gibson
- Marion County Public Health Department, Indianapolis, United States
| | - Valerie A Yeager
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, United States
| | - Paul K Halverson
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, United States
| | - Nir Menachemi
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, United States
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Nonnemaker J, MacMonegle AJ, Mann N, Woodlea R, Duke J, Porter L. Estimating the return on investment of the Bureau of Tobacco Free Florida tobacco control programme from 1999 to 2015. BMJ Open 2021; 11:e040012. [PMID: 33483438 PMCID: PMC7831704 DOI: 10.1136/bmjopen-2020-040012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/14/2020] [Accepted: 12/22/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the return on investment (ROI) of the Florida tobacco control programme, the Bureau of Tobacco Free Florida (BTFF), in terms of healthcare expenditure savings and mortality cost saved as a result of reduced mortality due to the programme from 1999 to 2015. METHODS We use a synthetic control method to estimate the impact of the BTFF on smoking-attributable mortality, years of life lost (YLL), healthcare expenditures, and the economic value of premature mortality due to smoking in Florida from 1999 through 2015. We calculated an ROI for healthcare expenditures and for the value of life years saved. RESULTS From 1999 to 2015, adult smoking prevalence in Florida averaged 0.98 percentage points lower than prevalence in the synthetic control states (19.6% vs 20.6%). The ROI over the period from 1999 to 2015 was 9.61 for healthcare expenditures and 112.44 for premature mortality. These ROIs suggest that for every US$1 of expenditure by BTFF, smoking-attributable healthcare expenditures decreased by almost US$11 and reductions in the economic costs associated with YLL due to smoking-attributable mortality totaled approximately US$113. CONCLUSIONS Our results suggest the BTFF resulted in fewer YLL, substantial healthcare cost savings and substantial savings in terms of mortality costs. The positive ROIs for healthcare expenditures and premature mortality suggest that the BTFF is a good investment of public funds.
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Affiliation(s)
- James Nonnemaker
- Center for Health Analytics, Media, and Policy, RTI International, Research Triangle Park, North Carolina, USA
| | - Anna J MacMonegle
- Center for Health Analytics, Media, and Policy, RTI International, Research Triangle Park, North Carolina, USA
| | - Nathan Mann
- Center for Health Analytics, Media, and Policy, RTI International, Research Triangle Park, North Carolina, USA
| | - Robyn Woodlea
- Center for Health Analytics, Media, and Policy, RTI International, Research Triangle Park, North Carolina, USA
| | - Jennifer Duke
- Center for Health Analytics, Media, and Policy, RTI International, Research Triangle Park, North Carolina, USA
| | - Lauren Porter
- Bureau of Tobacco Free Florida, Florida Department of Health, Tallahassee, Florida, USA
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Emmons KM, Chambers DA. Policy Implementation Science - An Unexplored Strategy to Address Social Determinants of Health. Ethn Dis 2021; 31:133-138. [PMID: 33519163 DOI: 10.18865/ed.31.1.133] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This commentary explores the ways in which robust research focused on policy implementation will increase our ability to understand how to - and how not to - address social determinants of health. We make three key points in this commentary. First, policies that affect our lives and health are developed and implemented every single day, like it or not. These include "small p" policies, such as those at our workplaces that influence whether we have affordable access to healthy food at work, as well as "large P" policies that, for example, determine at a larger level whether our children's schools are required to provide physical education. However, policies interact with context and are likely to have differential effects across different groups based on demographics, socioeconomic status, geography, and culture. We are unlikely to improve health equity if we do not begin to systematically evaluate the ways in which policies can incorporate evidence-based approaches to reducing inequities and to provide structural supports needed for such interventions to have maximal impact. A policy mandating physical education in schools will do little to address disparities in fitness and weight-related outcomes if all schools cannot provide the resources for physical education teachers and safe activity spaces. Second, as we argue for an increased emphasis on policy implementation science, we acknowledge its nascent status. Although the field of implementation science has become increasingly robust in the past decade, there has been only limited application to policy. However, if we are strategic and systematic in application of implementation science approaches and methods to health-related policy, there is great opportunity to discover its impact on social determinants. This will entail fundamental work to develop common measures of policy-relevant implementation processes and outcomes, to develop the capacity to track policy proposal outcomes, and to maximize our capacity to study natural experiments of policy implementation. Third, development of an explicit policy implementation science agenda focused on health equity is critical. This will include efforts to bridge scientific evidence and policy adoption and implementation, to evaluate policy impact on a range of health equity outcomes, and to examine differential effects of varied policy implementation processes across population groups. We cannot escape the reality that policy influences health and health equity. Policy implementation science can have an important bearing in understanding how policy impacts can be health-promoting and equitable.
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Affiliation(s)
| | - David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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Green BB, Meenan RT. Colorectal cancer screening: The costs and benefits of getting to 80% in every community. Cancer 2020; 126:4110-4113. [PMID: 32686080 DOI: 10.1002/cncr.32990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/21/2020] [Accepted: 05/04/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Beverly B Green
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA
| | - Richard T Meenan
- Kaiser Permanente Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
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Herbst N, Wiener RS, Helm ED, O'Donnell C, Fitzgerald C, Wong C, Bulekova K, Waite M, Mishuris RG, Kathuria H. Effectiveness of an Opt-Out Electronic Heath Record-Based Tobacco Treatment Consult Service at an Urban Safety Net Hospital. Chest 2020; 158:1734-1741. [PMID: 32428510 DOI: 10.1016/j.chest.2020.04.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 04/06/2020] [Accepted: 04/17/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To address the burden of tobacco use in underserved populations, our safety net hospital developed a tobacco treatment intervention consisting of an "opt-out" electronic health record-based best practice alert + order set, which triggers consultation to an inpatient tobacco treatment consult (TTC) service for all hospitalized smokers. RESEARCH QUESTION We sought to understand if the intervention would increase patient-level outcomes (receipt of tobacco treatment during hospitalization and at discharge; 6-month smoking abstinence) and improve hospital-wide performance on tobacco treatment metrics. DESIGN AND METHODS We conducted two retrospective quasi-experimental analyses to examine effectiveness of the TTC service. Using a pragmatic design and multivariable logistic regression, we compared patient-level outcomes of receipt of nicotine replacement therapy and 6-month quit rates between smokers seen by the service (n = 505) and eligible smokers not seen because of time constraints (n = 680) between July 2016 and December 2016. In addition, we conducted an interrupted time series analysis to examine the effect of the TTC service on hospital-level performance measures, comparing reported Joint Commission measure rates for inpatient (Tob-2) and postdischarge (Tob-3) tobacco treatment preimplementation (January 2015-June 2016) vs postimplementation (July 2016-December 2017) of the intervention. RESULTS Compared with inpatient smokers not seen by the TTC service, smokers seen by the TTC service had higher odds of receiving nicotine replacement during hospitalization (260 of 505 [51.5%] vs 244 of 680 [35.9%]; adjusted ORs [AOR], 1.93 [95% CI, 1.5-2.45]) and at discharge (164 of 505 [32.5%] vs 84 of 680 [12.4%]; AOR, 3.41 [95% CI, 2.54-4.61]), as well as higher odds of 6-month smoking abstinence (75 of 505 [14.9%] vs 68 of 680 [10%]; AOR, 1.48 [95% CI, 1.03-2.12]). Hospital-wide, the intervention was associated with a change in slope trends for Tob-3 (P < .01), but not for Tob-2. INTERPRETATION The "opt-out" electronic health record-based TTC service at our large safety net hospital was effective at improving both patient-level outcomes and hospital-level performance metrics, and could be implemented at other safety net hospitals that care for hard-to-reach smokers.
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Affiliation(s)
- Nicole Herbst
- Division of General Internal Medicine, Boston University School of Medicine, Boston, MA
| | - Renda Soylemez Wiener
- Pulmonary Center, Boston University School of Medicine, Boston, MA; Center for Healthcare Organization and Implementation Research, ENRM VA Hospital, Bedford, MA
| | - Eric D Helm
- Pulmonary Center, Boston University School of Medicine, Boston, MA
| | | | | | - Carolina Wong
- Pulmonary Center, Boston University School of Medicine, Boston, MA
| | - Katia Bulekova
- Research Computing Services Group, Information Services and Technology, Boston University, Boston, MA
| | - Meg Waite
- Analytics and Public Reporting, Boston Medical Center, Boston, MA
| | - Rebecca G Mishuris
- Division of General Internal Medicine, Boston University School of Medicine, Boston, MA
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DiGiulio A, Jump Z, Babb S, Schecter A, Williams KAS, Yembra D, Armour BS. State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments - United States, 2008-2018. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2020; 69:155-160. [PMID: 32053583 PMCID: PMC7017965 DOI: 10.15585/mmwr.mm6906a2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Beebe LA, Boeckman LM, Klein PG, Saul JE, Gillaspy SR. They Came, But Will They Come Back? An Observational Study of Re-Enrollment Predictors for the Oklahoma Tobacco Helpline. Am J Health Promot 2019; 34:261-268. [PMID: 31878792 DOI: 10.1177/0890117119890789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Although quitlines reach 1% to 2% of tobacco users annually, additional efforts are needed to increase their impact. We hypothesized that offering less intensive services would increase the rate of re-enrollment in any service, as well as re-enrollment in more intensive services. This study describes the enrollment patterns and identifies re-enrollment predictors for Oklahoma Tobacco Helpline (OTH) participants. DESIGN This study used a comparative observational design. SETTING The setting for this study was the OTH, a telephone-based cessation program funded by the Oklahoma Tobacco Settlement Endowment Trust. The OTH participants could select either a multicall telephone-based cessation program (MC) or one or more individual services (IS), including a 2-week nicotine replacement therapy (NRT) starter kit, e-mail or text-based support, and a printed quit guide. PARTICIPANTS A total of 35 648 first-time adult OTH participants eligible for the multicall program from October 2015 through September 2018 were included. MEASURES Demographic and tobacco use variables and initial quitline service selection were collected at intake. Additional service utilization was tracked for 6 months following initial registration. ANALYSIS Pearson chi-square and t tests were used to test for significant differences between groups. Multinomial logistic regression was used to examine predictors of re-enrollment. RESULTS Individual services were more frequently selected (n = 17 266) than MC (n = 14 326), despite all users being eligible for MC. A much higher proportion of IS registrants re-enrolled than MC registrants (16% vs 3%, P < .0001) Among the IS cohort, those who received an NRT follow-up call were 14.7 times more likely to re-enroll in IS, and 7.8 times more likely to re-enroll in MC, than those who were not reached by phone. CONCLUSIONS Access to free NRT without a telephone-coaching requirement is a draw for tobacco users, especially those with lower income and the uninsured. The results suggest the value of increasing use of nonphone services in an effort to increase interest in quitting and reach.
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Affiliation(s)
- Laura A Beebe
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Lindsay M Boeckman
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Paola G Klein
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jessie E Saul
- North American Research & Analysis, Inc, Hudson, WI, USA
| | - Stephen R Gillaspy
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
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Prochaska JJ, Benowitz NL. Current advances in research in treatment and recovery: Nicotine addiction. SCIENCE ADVANCES 2019; 5:eaay9763. [PMID: 31663029 PMCID: PMC6795520 DOI: 10.1126/sciadv.aay9763] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/26/2019] [Indexed: 05/05/2023]
Abstract
The health harms of combusted tobacco use are undeniable. With market and regulatory pressures to reduce the harms of nicotine delivery by combustion, the tobacco product landscape has diversified to include smokeless, heated, and electronic nicotine vaping products. Products of tobacco combustion are the main cause of smoking-induced disease, and nicotine addiction sustains tobacco use. An understanding of the biology and clinical features of nicotine addiction and the conditioning of behavior that occurs via stimuli paired with frequent nicotine dosing, as with a smoked cigarette, is important for informing pharmacologic and behavioral treatment targets. We review current advances in research on nicotine addiction treatment and recovery, with a focus on conventional combustible cigarette use. Our review covers evidence-based methods to treat smoking in adults and policy approaches to prevent nicotine product initiation in youth. In closing, we discuss emerging areas of evidence and consider new directions for advancing the field.
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Affiliation(s)
- Judith J. Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Neal L. Benowitz
- Program in Clinical Pharmacology, Division of Cardiology, and the Center for Tobacco Control Research and Education, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Maclean JC, Pesko MF, Hill SC. Public insurance expansions and smoking cessation medications. ECONOMIC INQUIRY 2019; 57:1798-1820. [PMID: 31427832 PMCID: PMC6699517 DOI: 10.1111/ecin.12794] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We study the effect of public insurance on smoking cessation medication prescriptions and financing. We leverage variation in insurance coverage generated by recent Affordable Care Act expansions to Medicaid. We estimate differences-in-differences models using administrative data on the universe of Medicaid-financed prescriptions sold in retail and online pharmacies 2011-2017. Our findings suggest that these expansions increased Medicaid-financed smoking cessation prescriptions by 34%. This increase reflects new medication use and a shift in payment from private insurers and self-paying patients to Medicaid. Adjusting our estimate for changes in financing implies that Medicaid expansion lead to a 24% increase in new medication use.
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Affiliation(s)
- Johanna Catherine Maclean
- Associate Professor, Department of Economics, Temple University, Research Associate, National Bureau of Economics, Research Affiliate, Institute for Labor Economics, Ritter Annex 869 -- 1301 Cecil B Moore Avenue, Philadelphia PA, 19122
| | - Michael F. Pesko
- Assistant Professor, Department of Economics, Andrew Young School of Policy Studies, Georgia State University, PO Box 3992, Atlanta GA, 30302-3992
| | - Steven C. Hill
- Senior Economist, Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, 5600 Fishers Lane, Mail Stop 07W41A, Rockville MD 20857
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Williams RK, Brookes RL, Singer ER. A Framework for Effective Promotion of a Medicaid Tobacco Cessation Benefit. Health Promot Pract 2019; 21:624-632. [PMID: 30786777 DOI: 10.1177/1524839919829452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tobacco burden is significantly greater among those insured by Medicaid, with a smoking prevalence about twice as high as the national average (28% vs. 15%). Over the past decade, smoking prevalence among those insured by Medicaid has remained relatively unchanged while overall smoking prevalence in the United States and among other insurance groups decreased. This indicates need for targeting tobacco control strategies to those insured by Medicaid. In response, the Vermont Tobacco Control Program (VTCP) set out to implement best practice by making its Medicaid cessation benefit more comprehensive and raising awareness and use of the benefit to support members in quitting. The VTCP collaborated with its Medicaid and health department leadership to implement this initiative, learning and adapting processes along the way. The VTCP identified a framework and considerations for programs implementing best practice to expand access and utilization of cessation supports. Elements of success include collaboration, data sharing, and promotion. As a result, the VTCP created an infrastructure that increases access, awareness, and use of cessation supports among Medicaid members and providers. Between 2013 and 2017, the quit ratio among Vermont Medicaid members increased from 8% to 13% and the smoking rate decreased from 36% to 31%.
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Hood-Medland EA, Dove MS, Stewart SL, Cummins SE, Kirby C, Vela C, Kohatsu ND, Tong EK. Direct-to-Member Household or Targeted Mailings: Incentivizing Medicaid Calls for Quitline Services. Am J Prev Med 2018; 55:S178-S185. [PMID: 30454672 DOI: 10.1016/j.amepre.2018.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 04/20/2018] [Accepted: 06/20/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Innovative methods are needed to promote tobacco cessation services. The Medi-Cal Incentives to Quit Smoking project (2012-2015) promoted modest financial and medication incentives to encourage Medi-Cal smokers to utilize the California Smokers' Helpline (Helpline). This article describes the implementation and impact of two different direct-to-member mailing approaches. METHODS Medi-Cal Incentives to Quit Smoking promotional materials were mailed directly to members using two approaches: (1) household mailings: households identified through centralized membership divisions and (2) individually targeted mailings: smokers identified by medical codes from Medi-Cal managed care plans. Mailings included messaging on incentives, such as gift cards or nicotine patches. Number of calls per month, calls per unit mailed, and associated printing costs per call were compared during and 1 month after mailings. Activated caller response was based on reporting a household mailing promotional code or based on requesting financial incentives for individually targeted mailings. Analyses were conducted in 2018. RESULTS Direct-to-member mailings, particularly with incentive messaging, demonstrated an increase in call volumes during and 1 month after mailing, and increased Medi-Cal calls to the Helpline per unit mailed. Mailings with only counseling messages had the lowest percentage of activated calls per unit mailed, whereas the incentive messaging mailings were consistently higher. Although household mailings demonstrated lower printing costs per call, individually targeted mailings had a higher percentage of activated calls per unit mailed. CONCLUSIONS Household and individually targeted mailings are feasible approaches to increase Medi-Cal calls to the Helpline, particularly with incentive messaging. Choosing an approach and messaging depends on available resources, timing, and purpose. SUPPLEMENT INFORMATION This article is part of a supplement entitled Advancing Smoking Cessation in California's Medicaid Population, which is sponsored by the California Department of Public Health.
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Affiliation(s)
| | - Melanie S Dove
- Department of Internal Medicine, University of California, Davis, Sacramento, California
| | - Susan L Stewart
- Department of Public Health Sciences, University of California, Davis, Sacramento, California
| | - Sharon E Cummins
- Moores Cancer Center, University of California, San Diego, San Diego, California
| | - Carrie Kirby
- Moores Cancer Center, University of California, San Diego, San Diego, California
| | - Cynthia Vela
- Department of Internal Medicine, University of California, Davis, Sacramento, California
| | - Neal D Kohatsu
- Kohatsu Consulting, Carmichael, California At the time of study, Dr. Kohatsu was with the Department of Health Care Services, Sacramento, California
| | - Elisa K Tong
- Department of Internal Medicine, University of California, Davis, Sacramento, California.
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Economic Impact of Financial Incentives and Mailing Nicotine Patches to Help Medicaid Smokers Quit Smoking: A Cost-Benefit Analysis. Am J Prev Med 2018; 55:S148-S158. [PMID: 30454669 DOI: 10.1016/j.amepre.2018.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/05/2018] [Accepted: 08/02/2018] [Indexed: 01/12/2023]
Abstract
An RCT designed to increase Medicaid smokers' quitting success was conducted in California during 2012-2013. In the trial, alternative cessation treatment strategies were embedded in the state's ongoing quitline services. It found that modest financial incentives of up to $60 per participant and sending nicotine patches induced significantly higher cessation rates compared with usual care alone and usual care plus nicotine patches. Building upon that study, this study assessed potential population-level costs and benefits of integrating financial incentives and nicotine patches in a quitline setting for Medicaid smokers. A cost-benefit analysis was undertaken from the Medicaid program's perspective. The Cardiovascular Disease Policy Model was used to simulate future healthcare expenditures over a 10-year horizon for each treatment strategy for a study cohort of California Medicaid enrollees who were aged 35-64 years in 2014 (n=2,452,000). To simulate potential population-level benefits under each treatment strategy, each treatment was applied to all active smokers in the study cohort (n=478,300). Sensitivity analyses were conducted by varying key parameters, such as cessation costs, discount rate, relapse rates, and time horizon. Adding both financial incentives and nicotine patches to usual quitline care would result in $15 million net savings over 10 years, with a benefit-cost ratio of 1.30 compared with the usual care plus nicotine patches strategy. It would yield $44 million net savings, with a benefit-cost ratio of 1.90 compared with usual care alone. The strategy of providing financial incentives and mailing nicotine patches directly to Medicaid smokers who call the quitline is cost saving. SUPPLEMENT INFORMATION: This article is part of a supplement entitled Advancing Smoking Cessation in California's Medicaid Population, which is sponsored by the California Department of Public Health.
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Zhu SH, Anderson CM, Wong S, Kohatsu ND. The Growing Proportion of Smokers in Medicaid and Implications for Public Policy. Am J Prev Med 2018; 55:S130-S137. [PMID: 30454667 DOI: 10.1016/j.amepre.2018.07.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/10/2018] [Accepted: 07/20/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION This study examined survey data from before and after California expanded its Medicaid program under the Affordable Care Act. It assessed changes in the insurance status of smokers, the proportion of smokers in Medicaid, and the health and well-being of those smokers relative to their counterparts in other insurance groups. METHODS The study compared two data sets from the California Health Interview Study, the 2011-2012 (N=42,935) and 2016 (N=21,055) surveys. Measures include health insurance status, smoking status, chronic health conditions, frequency of doctors' visits, and psychological distress. Data were analyzed in 2018. RESULTS From 2011-2012 to 2016, the estimated number of California smokers in Medicaid nearly doubled from 738,113 to 1,447,945, and the proportion of smokers covered by Medicaid increased from 19.3% to 41.5%. Compared with those with private insurance, smokers in Medicaid were more likely to have chronic disease, have made five or more doctors' visits in the past year, and be in severe psychological distress. In 2016, a total of 51.4% of all adult smokers with chronic disease conditions and 57.8% of those in severe psychological distress were covered by Medicaid. CONCLUSIONS With Medicaid covering a much higher proportion of smokers, especially of those smokers with chronic disease and in psychological distress, state Medicaid programs and plans must make tobacco cessation a top priority. They should encourage clinicians to ask, advise, and assist all smokers, track progress in reducing smoking prevalence, employ mass communication strategies to drive quit attempts, improve access to medications, and develop or expand programs to help smokers quit. SUPPLEMENT INFORMATION This article is part of a supplement entitled Advancing Smoking Cessation in California's Medicaid Population, which is sponsored by the California Department of Public Health.
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Affiliation(s)
- Shu-Hong Zhu
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California; Moores Cancer Center, University of California, San Diego, La Jolla, California.
| | | | - Shiushing Wong
- Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Neal D Kohatsu
- Kohatsu Consulting, Carmichael, CaliforniaAt the time of study, Dr. Kohatsu was with the Department of Health Care Services, Sacramento, California
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Holla N, Brantley E, Ku L. Physicians' Recommendations to Medicaid Patients About Tobacco Cessation. Am J Prev Med 2018; 55:762-769. [PMID: 30344039 DOI: 10.1016/j.amepre.2018.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 05/31/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Smoking is highly prevalent among low-income Medicaid beneficiaries and tobacco-cessation benefits are generally available. Nonetheless, use of cessation medications or counseling remains low, and many clinicians are hesitant to urge smokers to quit. This study examines the extent to which physicians provide advice to Medicaid patients about quitting. METHODS Data from the 2014-2015 Nationwide Adult Medicaid Consumer Assessment of Health Plans survey were merged with state Medicaid policy variables and analyzed in 2017-2018. Multivariate regression models examined factors associated with smoking status, physician advice to quit smoking, and discussion of cessation medications or other strategies, as well as patients' ratings of their personal physicians. RESULTS Almost one third (29%) of adult Medicaid beneficiaries smoke. Almost four fifths of smokers with a personal doctor (77%) say their doctor at least sometimes advised quitting and almost half of smokers discussed cessation medications (48%), or another strategy, such as counseling (42%). Smokers' ratings of satisfaction with their physicians and their health plans rose as the frequency of smoking recommendations increased. Those in Medicaid managed care plans smoked more, but received less advice about cessation medications than those in fee-for-service care. CONCLUSIONS Clinicians and Medicaid managed care plans can improve their efforts to motivate Medicaid patients to try to quit smoking. These findings indicate that patients value prevention-oriented advice and give better ratings to physicians and health plans that offer more support and advice about cessation.
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Affiliation(s)
- Nikhil Holla
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Erin Brantley
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Leighton Ku
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia.
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Roeseler A, Kohatsu ND. Advancing Smoking Cessation in California's Medicaid Population. Am J Prev Med 2018; 55:S126-S129. [PMID: 30454666 DOI: 10.1016/j.amepre.2018.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 05/15/2018] [Accepted: 07/20/2018] [Indexed: 10/27/2022]
Affiliation(s)
- April Roeseler
- California Tobacco Control Program, California Department of Public Health, Sacramento, California.
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Tong EK, Stewart SL, Schillinger D, Vijayaraghavan M, Dove MS, Epperson AE, Vela C, Kratochvil S, Anderson CM, Kirby CA, Zhu SH, Safier J, Sloss G, Kohatsu ND. The Medi-Cal Incentives to Quit Smoking Project: Impact of Statewide Outreach Through Health Channels. Am J Prev Med 2018; 55:S159-S169. [PMID: 30454670 DOI: 10.1016/j.amepre.2018.07.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/30/2018] [Accepted: 07/24/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Little is known about how incentives may encourage low income smokers to call for quitline services. This study evaluates the impact of outreach through health channels on California Medicaid (Medi-Cal) quitline caller characteristics, trends, and reach. STUDY DESIGN Longitudinal study. SETTING/PARTICIPANTS Medi-Cal quitline callers. INTERVENTION Statewide outreach was conducted with health providers, Medi-Cal plans (all-household mailings with tracking codes), and public health organizations (March 2012-July 2015). For incentives, Medi-Cal callers could ask for a $20 gift card; in September 2013, callers were offered free nicotine patches. MAIN OUTCOME MEASURES Caller characteristics were compared with chi-square analyses, joinpoint analysis of call trends was performed accounting for Medi-Cal population growth, referral source among Medi-Cal and non-Medi-Cal callers was documented, and the annual percentage of the population reached who called the Helpline was calculated. Analyses were conducted 2016-2018. RESULTS Total Medi-Cal callers were 92,900, a 70% increase from prior annual averages: 12.4% asked for the financial incentive, 17.3% reported the mailing code, and 73.3% received nicotine patches while offered. Among the two thirds of callers who completed counseling, 15.5% asked for the financial incentive, and 13.6% reported the mailing code. A joinpoint analysis showed call trends increased 23% above expected for the Medi-Cal population growth after mailings to providers and members began, and decreased after outreach ended. Annual reach increased from 2.3% (95% CI=2.1, 2.6) in 2011 to peak at 4.5% (95% CI=3.6, 5.3) in 2014. Among subgroups with higher reach rates, some also had higher rates of asking for the financial incentive (African Americans, American Indian), reporting the tracking code (whites), or both (aged 45-64 years). Medi-Cal callers were more likely than non-Medi-Cal callers to report providers (32.3% vs 23.8%) and plans (19.7% vs 1.4%) as their referral source, and less likely to cite media (20.2% vs 44.4%, p<0.001). CONCLUSIONS Statewide outreach through health channels incentivizing Medi-Cal members increased the utilization and reach of quitline services. SUPPLEMENT INFORMATION This article is part of a supplement entitled Advancing Smoking Cessation in California's Medicaid Population, which is sponsored by the California Department of Public Health.
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Affiliation(s)
- Elisa K Tong
- Department of Internal Medicine, University of California, Davis, Sacramento, California.
| | - Susan L Stewart
- Department of Public Health Sciences, University of California, Davis, Sacramento, California
| | - Dean Schillinger
- Department of Internal Medicine, University of California, San Francisco, San Francisco, California
| | - Maya Vijayaraghavan
- Department of Internal Medicine, University of California, San Francisco, San Francisco, California
| | - Melanie S Dove
- Department of Internal Medicine, University of California, Davis, Sacramento, California
| | - Anna E Epperson
- Stanford Prevention Research Center, Stanford University, Stanford, California
| | - Cynthia Vela
- Department of Internal Medicine, University of California, Davis, Sacramento, California
| | | | - Christopher M Anderson
- California Smokers' Helpline, University of California, San Diego, San Diego, California
| | - Carrie A Kirby
- California Smokers' Helpline, University of California, San Diego, San Diego, California
| | - Shu-Hong Zhu
- California Smokers' Helpline, University of California, San Diego, San Diego, California
| | - Jessica Safier
- Smoking Cessation Leadership Center, University of California, San Francisco, San Francisco, California
| | - Gordon Sloss
- California Department of Public Health, Sacramento, California
| | - Neal D Kohatsu
- Kohatsu Consulting, Carmichael, CaliforniaAt the time of study, Dr. Kohatsu was with the Department of Health Care Services, Sacramento, California
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Mossanen M, Caldwell J, Sonpavde G, Lehmann LS. Treating Patients With Bladder Cancer: Is There an Ethical Obligation to Include Smoking Cessation Counseling? J Clin Oncol 2018; 36:3189-3191. [DOI: 10.1200/jco.18.00577] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Matthew Mossanen
- Matthew Mossanen, Brigham and Women’s Hospital, Harvard Medical School, Center for Surgery and Public Health, Brigham and Women’s Hospital; and Dana-Farber Cancer Institute, Boston, MA; Joshua Caldwell, Harvard Medical School, Boston, MA; Guru Sonpavde, Dana-Farber Cancer Institute, Boston, MA; and Lisa Soleymani Lehmann, National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC, and Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA
| | - Joshua Caldwell
- Matthew Mossanen, Brigham and Women’s Hospital, Harvard Medical School, Center for Surgery and Public Health, Brigham and Women’s Hospital; and Dana-Farber Cancer Institute, Boston, MA; Joshua Caldwell, Harvard Medical School, Boston, MA; Guru Sonpavde, Dana-Farber Cancer Institute, Boston, MA; and Lisa Soleymani Lehmann, National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC, and Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA
| | - Guru Sonpavde
- Matthew Mossanen, Brigham and Women’s Hospital, Harvard Medical School, Center for Surgery and Public Health, Brigham and Women’s Hospital; and Dana-Farber Cancer Institute, Boston, MA; Joshua Caldwell, Harvard Medical School, Boston, MA; Guru Sonpavde, Dana-Farber Cancer Institute, Boston, MA; and Lisa Soleymani Lehmann, National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC, and Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA
| | - Lisa Soleymani Lehmann
- Matthew Mossanen, Brigham and Women’s Hospital, Harvard Medical School, Center for Surgery and Public Health, Brigham and Women’s Hospital; and Dana-Farber Cancer Institute, Boston, MA; Joshua Caldwell, Harvard Medical School, Boston, MA; Guru Sonpavde, Dana-Farber Cancer Institute, Boston, MA; and Lisa Soleymani Lehmann, National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC, and Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA
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Verghese C, Redko C, Fink B. Screening for Lung Cancer Has Limited Effectiveness Globally and Distracts From Much Needed Efforts to Reduce the Critical Worldwide Prevalence of Smoking and Related Morbidity and Mortality. J Glob Oncol 2018; 4:1-7. [PMID: 30241213 PMCID: PMC6181518 DOI: 10.1200/jgo.2017.1700016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Cherian Verghese
- Cherian Verghese and Brian Fink, University
of Toledo Medical Center, Toledo; and Cristina Redko, Wright State
University, Dayton, OH
| | - Cristina Redko
- Cherian Verghese and Brian Fink, University
of Toledo Medical Center, Toledo; and Cristina Redko, Wright State
University, Dayton, OH
| | - Brian Fink
- Cherian Verghese and Brian Fink, University
of Toledo Medical Center, Toledo; and Cristina Redko, Wright State
University, Dayton, OH
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Baker CL, Ding Y, Ferrufino CP, Kowal S, Tan J, Subedi P. A cost-benefit analysis of smoking cessation prescription coverage from a US payer perspective. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:359-370. [PMID: 30038510 PMCID: PMC6052927 DOI: 10.2147/ceor.s165576] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Smoking drives substantial direct health care spending, comprising 8.7% ($168 billion) of annual United States aggregated spending. Smoking cessation (SC) prescription use is an effective strategy to improve health outcomes, increase quit rates, and reduce economic burden. However, patient out-of-pocket costs may limit the use. Health care payers play a vital role in driving use through formulary decisions and copayment policies but must consider both the near-term financial investment as well as downstream effects of increased coverage on health care budgets. This study estimates the return on investment (ROI) of providing Affordable Care Act (ACA)-recommended prescription SC coverage. Methods A cost–benefit analysis (CBA) estimates the ROI of providing prescription SC coverage, based on pharmacy costs and savings from smoking-attributable medical expenditures among Medicare, Medicaid, and commercial plan enrollees over 10 years. The CBA incorporated national-level population demographics, smoking prevalence estimates, proportion of smokers attempting to quit, and the utilization of SC products. A five-state Markov chain model simulated patterns of quit attempts, relapse, and cessation assuming two quit attempts per year, no patient cost-sharing, and 25.4% utilization of prescription SC aids. Results include number of quitters, annual pharmacy and smoking-attributable medical costs, and ROI. Results After initial investment in SC treatment, smoking-attributable medical benefits accrue over time, generating a positive ROI by year 4 for commercial (11.3%) and Medicaid (78.4%) plans and by year 3 for Medicare (30.6%). Over 10 years, an average return of $1.18, $2.50, and $3.22 savings per dollar spent on SC prescriptions for commercial, Medicaid, and Medicare plans, respectively, may be realized. Discussion Given the proven efficacy of SC pharmacotherapy, near-term investments in supporting ACA-recommended SC coverage translate into a positive ROI. As smoking is a leading cause of morbidity and mortality, increased access to prescription SC medications may improve health outcomes and reduce smoking-attributable costs to payers over time.
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Affiliation(s)
| | - Yao Ding
- Health Economics & Outcomes Research, Real World Evidence Solutions, IQVIA, Fairfax, VA, USA,
| | - Cheryl P Ferrufino
- Health Economics & Outcomes Research, Real World Evidence Solutions, IQVIA, Fairfax, VA, USA,
| | - Stacey Kowal
- Health Economics & Outcomes Research, Real World Evidence Solutions, IQVIA, Fairfax, VA, USA,
| | | | - Prasun Subedi
- Patient & Health Impact, Pfizer, Inc, New York, NY, USA
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Richter KP, Shergina E, Grodie A, Massey JK, Ellerbeck EF, Applegate A, Faseru B. Direct observation of Medicaid beneficiary attempts to fill prescriptions for nicotine replacement medications. J Am Pharm Assoc (2003) 2018; 58:432-437. [PMID: 29691198 DOI: 10.1016/j.japh.2018.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 03/22/2018] [Accepted: 03/27/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Although many states have expanded Medicaid coverage of cessation medications, utilization remains low. Anecdotal reports suggest that beneficiaries are at times denied coverage of cessation medications at the pharmacy counter. We conducted an observational community-wide case study of Medicaid beneficiary attempts to fill over-the-counter nicotine replacement therapy at pharmacies. METHODS We recruited tobacco-using beneficiaries from a Federally Qualified Health Center, whose providers wrote paper prescriptions for nicotine patches. Study staff escorted beneficiaries to all eligible pharmacies (n = 18) in a Midwestern community to observe fill attempts. Study staff recorded encounters via smartphone into a secure database on a university server. RESULTS Seven of 18 pharmacies (39%) did not fill the prescription on the day of the attempt. Of these, 6 offered to order the patch for pick-up at a later date. All (4/4) chain pharmacies filled the prescription; 2/3 mass merchant pharmacies failed to fill. Combining successful same-day fills with offers to order for pick-up, 17/18 (94%) would ultimately have been able to obtain patches. CONCLUSION This pilot study found that many beneficiaries left pharmacies without a prescription in hand. Successful same-day fills varied markedly by store type. For people with low incomes, transportation presents a major barrier for delayed pick-up. In addition, delays can fuel ambivalence toward quitting. Future research based on this pilot study might address whether patients who fail to secure a same-day prescription ever fill the prescription and, if not, the degree to which this barrier contributes to success or failure in quitting.
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DiGiulio A, Jump Z, Yu A, Babb S, Schecter A, Williams KAS, Yembra D, Armour BS. State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments - United States, 2015-2017. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2018; 67:390-395. [PMID: 29621205 PMCID: PMC5889244 DOI: 10.15585/mmwr.mm6713a3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Naavaal S, Malarcher A, Xu X, Zhang L, Babb S. Variations in Cigarette Smoking and Quit Attempts by Health Insurance Among US Adults in 41 States and 2 Jurisdictions, 2014. Public Health Rep 2018; 133:191-199. [PMID: 29471727 PMCID: PMC5871139 DOI: 10.1177/0033354917753120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Information on the impact of health insurance on smoking and quit attempts at the state level is limited. We examined the state-specific prevalence of cigarette smoking and past-year quit attempts among adults aged 18-64 by health insurance and other individual- and state-level factors. METHODS We used data from 41 states, the District of Columbia, and Puerto Rico, the jurisdictions that administered the Health Care Access module of the 2014 Behavioral Risk Factor Surveillance System. Data on quit attempts included current smokers with a past-year quit attempt and former smokers who quit during the past year. RESULTS Overall, smoking prevalence ranged from 14.6% among those with private insurance to 34.7% among Medicaid enrollees, and past-year quit-attempt prevalence ranged from 66.4% among the uninsured to 71.5% among Medicaid enrollees. By insurance group, differences in the prevalence of state-specific past-year quit attempts ranged from 15 to 26 percentage points. Regardless of insurance type, people who were non-Hispanic white and had lower education levels were less likely to attempt quitting than were Hispanic people, non-Hispanic black people, and adults with more than a high school education. CONCLUSIONS We found disparities in smoking and quit attempts by insurance status and state. Opportunities exist to increase access to cessation treatments through comprehensive state tobacco control programs and improved cessation insurance coverage, coupled with promotion of covered cessation treatments.
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Affiliation(s)
- Shillpa Naavaal
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Current Affiliation: Oral Health Promotion and Community Outreach, Philips Institute of Oral Health Research, School of Dentistry, Virginia Commonwealth University, Richmond, VA, USA
| | - Ann Malarcher
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Xin Xu
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lei Zhang
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephen Babb
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Knox B, Mitchell S, Hernly E, Rose A, Sheridan H, Ellerbeck EF. Barriers to Utilizing Medicaid Smoking Cessation Benefits. Kans J Med 2017; 10:1-11. [PMID: 29472979 PMCID: PMC5733401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Smoking is the number one preventable cause of death in the United States. Under the Affordable Care Act, Kansas Medicaid covers all seven FDA-approved smoking cessation therapies. However, it is estimated only 3% of Kansas Medicaid smokers use treatment compared to the national estimate of 10%. The objective is to determine systemic barriers in place that prevent optimal utilization of Medicaid smoking cessation benefits among KU Medical Center Internal Medicine patients. METHODS For this quality improvement project, a population of 169 Kansas Medicaid smokers was identified who had been seen at the KU Internal Medicine Clinic from January 1, 2015 - February 16, 2016. Phone surveys were completed with 62 individuals about smoking status, interest in using smoking cessation treatment options, and awareness of Medicaid coverage of treatment. RESULTS Of the 62 respondents, 24 (39%) were prescribed pharmacotherapy and 41 (66%) were interested in using smoking cessation treatment. There were eight who had quit smoking. Of the remaining 54 smokers, 31 (57%) were unaware that Medicaid would cover pharmacotherapy. Of 24 participants who received a prescription for pharmacotherapy, 13 (54%) were able to fill the prescription at no cost using the Medicaid benefit. CONCLUSIONS The majority of respondents were interested in using smoking cessation treatment yet three main barriers existed to using Medicaid smoking cessation benefits: physicians not prescribing treatment to patients, patients not aware of Medicaid coverage, and inadequate pharmacy filling. Improved physician and patient awareness of Medicaid coverage will facilitate more patients receiving smoking cessation therapy and ultimately quitting smoking.
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Fitzpatrick MC, Singer BH, Hotez PJ, Galvani AP. Saving lives efficiently across sectors: the need for a Congressional cost-effectiveness committee. Lancet 2017; 390:2410-2412. [PMID: 28669643 PMCID: PMC5960984 DOI: 10.1016/s0140-6736(17)31440-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/23/2017] [Accepted: 03/28/2017] [Indexed: 11/20/2022]
Affiliation(s)
- Meagan C Fitzpatrick
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Peter J Hotez
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA; Texas Children's Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, TX, USA; Center for Health and Biosciences, James A Baker III Institute for Public Policy, Rice University, Houston, TX, USA
| | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA; Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT, USA.
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Abstract
BACKGROUND Lung cancer is the most preventable leading cause of cancer death in the United States. Smoking while receiving treatment for lung cancer can decrease the effectiveness of the treatment and may reduce quality of life. Although many smoking cessation proposals have focused on how to deliver various interventions, they have neglected the issue of how to sustain the interventions and integrate them into practice. OBJECTIVES The purpose of this article is to provide an effective way of educating healthcare professionals (HCPs) on smoking cessation interventions that meet the U.S. Department of Health and Human Services' 2008 evidence-based clinical practice guidelines. METHODS This article reviews strategies to integrate evidence from research on smoking cessation into practice in sustainable ways that target patients with lung cancer who smoke. FINDINGS HCPs need evidence-based smoking cessation guidelines, along with interventions that will be effective with their specific smoking population. In addition, HCPs need to incorporate clinical practice guidelines for smoking cessation into their care of patients in ways that can be sustained and evaluated.
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Masters R, Anwar E, Collins B, Cookson R, Capewell S. Return on investment of public health interventions: a systematic review. J Epidemiol Community Health 2017; 71:827-834. [PMID: 28356325 PMCID: PMC5537512 DOI: 10.1136/jech-2016-208141] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 02/03/2017] [Indexed: 12/02/2022]
Abstract
BACKGROUND Public sector austerity measures in many high-income countries mean that public health budgets are reducing year on year. To help inform the potential impact of these proposed disinvestments in public health, we set out to determine the return on investment (ROI) from a range of existing public health interventions. METHODS We conducted systematic searches on all relevant databases (including MEDLINE; EMBASE; CINAHL; AMED; PubMed, Cochrane and Scopus) to identify studies that calculated a ROI or cost-benefit ratio (CBR) for public health interventions in high-income countries. RESULTS We identified 2957 titles, and included 52 studies. The median ROI for public health interventions was 14.3 to 1, and median CBR was 8.3. The median ROI for all 29 local public health interventions was 4.1 to 1, and median CBR was 10.3. Even larger benefits were reported in 28 studies analysing nationwide public health interventions; the median ROI was 27.2, and median CBR was 17.5. CONCLUSIONS This systematic review suggests that local and national public health interventions are highly cost-saving. Cuts to public health budgets in high income countries therefore represent a false economy, and are likely to generate billions of pounds of additional costs to health services and the wider economy.
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Affiliation(s)
- Rebecca Masters
- North Wales Local Public Health Team, Public Health Wales, Mold, Flintshire, UK
- Department of Public Health and Policy, University of Liverpool, UK
| | - Elspeth Anwar
- Department of Public Health and Policy, University of Liverpool, UK
- Department of Public Health, Halton Borough Council, Cheshire, UK
- Department of Public Health, Wirral Metropolitan Borough Council, Merseyside, UK
| | - Brendan Collins
- Department of Public Health and Policy, University of Liverpool, UK
- Department of Public Health, Wirral Metropolitan Borough Council, Merseyside, UK
| | | | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, UK
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Zhu SH, Anderson CM, Zhuang YL, Gamst AC, Kohatsu ND. Smoking prevalence in Medicaid has been declining at a negligible rate. PLoS One 2017; 12:e0178279. [PMID: 28542637 PMCID: PMC5479677 DOI: 10.1371/journal.pone.0178279] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 05/10/2017] [Indexed: 12/03/2022] Open
Abstract
Background In 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 findings National 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. Results Adjusted 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). Conclusions The 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.
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Affiliation(s)
- Shu-Hong Zhu
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California, United States of America
- Moores Cancer Center, University of California, San Diego, La Jolla, California, United States of America
- * E-mail:
| | - Christopher M. Anderson
- Moores Cancer Center, University of California, San Diego, La Jolla, California, United States of America
| | - Yue-Lin Zhuang
- Moores Cancer Center, University of California, San Diego, La Jolla, California, United States of America
| | - Anthony C. Gamst
- Moores Cancer Center, University of California, San Diego, La Jolla, California, United States of America
- Department of Mathematics, University of California, San Diego, La Jolla, California, United States of America
| | - Neal D. Kohatsu
- Department of Health Care Services, Sacramento, California, United States of America
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Abstract
In the past two decades, we and others have estimated that more than half of cancers could have been prevented by applying knowledge that we already have. Tobacco use, inactivity, and obesity are modifiable causes of cancer,– and evidence now suggests that vaccination against the human papillomavirus, the use of aspirin and selective estrogen-receptor modulators, and participation in screening programs further reduce the risk of specific cancers., The effect of these strategies on cancer-related outcomes in the general population is significant. A 62% reduction in lung-cancer mortality is associated with smoking cessation at age 50, and environmental and policy strategies are effective at increasing cessation.– A 95% reduction in mortality is associated with screening for cervical cancer, a 100% reduction in mortality is associated with vaccination against the human papillomavirus, – and a 90% reduction in mortality related to chronic liver disease and liver cancer is associated with vaccination against hepatitis B virus. There is also benefit for those at high risk for cancer. Lung-cancer screening is associated with a 20% reduction in mortality among smokers at high risk, salpingo-oophorectomy reduces the risk of breast and ovarian cancer among women with a BRCA1/2 mutation,, and treatment with selective estrogen receptor modulators reduces the incidence of breast cancer by 50% among women at high risk., Screening, diagnosis, and treatment of hepatitis C virus infection reduces the risk of all-cause mortality by 50% among those with infection. Our ability to prevent cancer has improved significantly.
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Affiliation(s)
- Karen M Emmons
- From the Harvard T.H. Chan School of Public Health, Boston (K.M.E.); and the Division of Public Health Sciences, Washington University School of Medicine, St. Louis (G.A.C.)
| | - Graham A Colditz
- From the Harvard T.H. Chan School of Public Health, Boston (K.M.E.); and the Division of Public Health Sciences, Washington University School of Medicine, St. Louis (G.A.C.)
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Ku L, Steinmetz E, Bysshe T, Bruen BK. Crossing Boundaries. Public Health Rep 2017; 132:164-170. [PMID: 28192676 DOI: 10.1177/0033354917692954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Previous state interagency collaborations have led to successful tobacco cessation initiatives. The objective of this study was to assess the roles and interaction of state Medicaid and public health agency efforts to support tobacco cessation for low-income Medicaid beneficiaries. METHODS We interviewed Medicaid and state public health agency officials in 8 states in September and October 2015 about collaborations in policy development and implementation for Medicaid tobacco cessation, including Medicaid coverage policies, quitlines, and monitoring. RESULTS Collaboration between Medicaid and public health agencies was limited. Smoking cessation quitlines were the most common area of collaboration cited. Public health officials were typically not involved in developing Medicaid coverage policies. States covered a range of US Food and Drug Administration-approved tobacco cessation medications, but 7 of the 8 states imposed limitations, such as charging copayments or requiring previous authorization. States generally lacked data to monitor implementation of tobacco cessation efforts and had little ability to determine the effectiveness of their policies. CONCLUSIONS To strengthen efforts to reduce smoking and tobacco-related health burdens and to monitor the effectiveness of policies and programs, Medicaid and public health agencies should prioritize tobacco cessation and develop and analyze data about smoking and cessation efforts among Medicaid beneficiaries. Recent multistate initiatives from the Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services seek to promote stronger collaborations in clinical prevention activities, including tobacco cessation.
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Affiliation(s)
- Leighton Ku
- 1 Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Erika Steinmetz
- 1 Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Tyler Bysshe
- 1 Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Brian K Bruen
- 1 Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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Ku L, Bruen BK, Steinmetz E, Bysshe T. Medicaid Tobacco Cessation: Big Gaps Remain In Efforts To Get Smokers To Quit. Health Aff (Millwood) 2017; 35:62-70. [PMID: 26733702 DOI: 10.1377/hlthaff.2015.0756] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Medicaid enrollees are about twice as likely as the general US population to smoke tobacco: 32 percent of people in the program identify themselves as smokers. This article provides the first data about the effectiveness of state Medicaid programs in promoting smoking cessation. Our analysis of Medicaid enrollees' use of cessation medications found that about 10 percent of current smokers received cessation medications in 2013. Every state Medicaid program covers cessation benefits, but the use of these medications varies widely, with the rate in Minnesota being thirty times higher than that in Texas. Most states could increase their efforts to help smokers quit, working with public health agencies, managed care plans, and others. In 2013 Medicaid spent $103 million on cessation medications-less than 0.25 percent of the estimated cost to Medicaid of smoking-related diseases. Additionally, states that have not expanded Medicaid eligibility in the wake of the Affordable Care Act have higher smoking prevalence and lower utilization rates of cessation medication, compared to expansion states. Given these factors, nonexpansion states will have a greater public health burden related to smoking. Medicaid and public health agencies should work together to make smoking cessation a priority for Medicaid beneficiaries.
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Affiliation(s)
- Leighton Ku
- Leighton Ku is a professor of health policy and management and director of the Center for Health Policy Research at the George Washington University, in Washington, D.C
| | - Brian K Bruen
- Brian K. Bruen is a lead research scientist and lecturer in the Department of Health Policy and Management at the George Washington University
| | - Erika Steinmetz
- Erika Steinmetz is a senior research scientist in the Milken Institute School of Public Health at the George Washington University
| | - Tyler Bysshe
- Tyler Bysshe is a senior research assistant in the Milken Institute School of Public Health at the George Washington University
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Impact of Increasing Coverage for Select Smoking Cessation Therapies With no Out-of-Pocket Cost Among the Medicaid Population in Alabama, Georgia, and Maine. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 22:40-7. [PMID: 26131658 DOI: 10.1097/phh.0000000000000302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Prevalence of smoking is particularly high among individuals with low socioeconomic status and who may be receiving Medicaid benefits. This study evaluates the public health and economic impact of providing coverage for nicotine replacement therapy with no out-of-pocket cost to the adult Medicaid population in Alabama, Georgia, and Maine, in 2012. We estimated the increase in the number of quitters and the savings in Medicaid medical expenditures associated with expanding Medicaid coverage of nicotine replacement therapy to the entire adult Medicaid population in the 3 states. With an expansion of Medicaid coverage of nicotine replacement therapy from only pregnant women to all adult Medicaid enrollees, the state of Alabama might expect 1873 to 2810 additional quitters ($526,203 and $789,305 in savings of annual Medicaid expenditures from both federal and state funds), Georgia 2911 to 4367 additional quits ($1,455,606 and $2,183,409 savings), and Maine 1511 to 2267 additional quits in ($431,709 and $647,564 savings). The expansion of coverage for smoking cessation therapy with no out-of-pocket cost could reduce Medicaid expenditures in all 3 states.
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The Tobacco Control Network's Policy Readiness and Stage of Change Assessment: What the Results Suggest for Moving Tobacco Control Efforts Forward at the State and Territorial Levels. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 22:9-19. [PMID: 25822902 DOI: 10.1097/phh.0000000000000247] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT The Tobacco Control Network (TCN) is comprised of the tobacco control programs in the health departments of states, territories, and the District of Columbia. During the assessment period, the TCN was managed by the Tobacco Technical Assistance Consortium at Emory University. OBJECTIVE To assess the readiness of state and territory tobacco control programs to work on evidence-based, promising policy and system change strategies aimed at preventing and reducing tobacco use and secondhand smoke exposure. DESIGN The Policy Readiness and Stage of Change Assessment was a Web-based survey fielded in September 2013, which was based on the Community Readiness Model. SETTING Fifty-nine comprehensive tobacco control programs. PARTICIPANTS State and territory tobacco control program managers and their internal and external partners. INTERVENTION The TCN's 2012 Policy Platform recommendations were used as the basis to assess state/territory readiness to adopt and implement evidence-based and promising tobacco control policy/system change strategies. MAIN OUTCOME MEASURES Sixteen tobacco control strategies were rated on: (1) implementation status, (2) readiness, (3) stage of change, and (4) the appropriate level of action for work on the strategy. RESULTS The 3 strategies with the highest readiness scores were as follows: (1) 100% smoke-free air in workplaces (64%), (2) tobacco-free schools (61%), and (3) $1.50 or less cigarette tax with funds to tobacco control (53%). The 3 strategies with lowest readiness scores were: 1) coupon redemption (17%), 2) tobacco mitigation fee (14%), and 3) disclosure or sunshine laws (8%). CONCLUSION Readiness to work on tobacco control strategies varied by region and strategy. Many states/territories are ready to work on strategies for which there is less evidence of a population-level impact for reducing tobacco use, but which contribute to denormalizing tobacco use. Working toward less impactful policies may build support, capacity, and policy success, laying an important foundation to achieve more impactful strategies.
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Abstract
Tobacco use remains the leading preventable cause of death worldwide. In particular, people with mental illness are disproportionately affected with high smoking prevalence; they account for more than 200,000 of the 520,000 tobacco-attributable deaths in the United States annually and die on average 25 years prematurely. Our review aims to provide an update on smoking in the mentally ill. We review the determinants of tobacco use among smokers with mental illness, presented with regard to the public health HAVE framework of “the host” (e.g., tobacco user characteristics), the “agent” (e.g., nicotine product characteristics), the “vector” (e.g., tobacco industry), and the “environment” (e.g., smoking policies). Furthermore, we identify the significant health harms incurred and opportunities for prevention and intervention within a health care systems and larger health policy perspective. A comprehensive effort is warranted to achieve equity toward the 2025 Healthy People goal of reducing US adult tobacco use to 12%, with attention to all subgroups, including smokers with mental illness.
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Affiliation(s)
- Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California 94305;
| | - Smita Das
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California 94305;
| | - Kelly C Young-Wolff
- Division of Research, Kaiser Permanente Northern California, Oakland, California 94612;
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DiGiulio A, Haddix M, Jump Z, Babb S, Schecter A, Williams KAS, Asman K, Armour BS. State Medicaid Expansion Tobacco Cessation Coverage and Number of Adult Smokers Enrolled in Expansion Coverage — United States, 2016. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2016; 65:1364-1369. [DOI: 10.15585/mmwr.mm6548a2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Mendes ACR, Toscano CM, Barcellos RMDS, Ribeiro ALP, Ritzel JB, Cunha VDS, Duncan BB. Costs of the Smoking Cessation Program in Brazil. Rev Saude Publica 2016; 50:66. [PMID: 27849293 PMCID: PMC5117528 DOI: 10.1590/s1518-8787.2016050006303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 10/11/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the costs of the Smoking Cessation Program in the Brazilian Unified Health System and estimate the cost of its full implementation in a Brazilian municipality. METHODS The intensive behavioral therapy and treatment for smoking cessation includes consultations, cognitive-behavioral group therapy sessions, and use of medicines. The costs of care and management of the program were estimated using micro-costing methods. The full implementation of the program in the municipality of Goiania, Goias was set as its expansion to meet the demand of all smokers motivated to quit in the municipality that would seek care at Brazilian Unified Health System. We considered direct medical and non-medical costs: human resources, medicines, consumables, general expenses, transport, travels, events, and capital costs. We included costs of federal, state, and municipal levels. The perspective of the analysis was that from the Brazilian Unified Health System. Sensitivity analysis was performed by varying parameters concerning the amount of activities and resources used. Data sources included a sample of primary care health units, municipal and state secretariats of health, and the Brazilian Ministry of Health. The costs were estimated in Brazilian Real (R$) for the year of 2010. RESULTS The cost of the program in Goiania was R$429,079, with 78.0% regarding behavioral therapy and treatment of smoking. The cost per patient was R$534, and, per quitter, R$1,435. The full implementation of the program in the municipality of Goiania would generate a cost of R$20.28 million to attend 35,323 smokers. CONCLUSIONS The Smoking Cessation Program has good performance in terms of cost per patient that quit smoking. In view of the burden of smoking in Brazil, the treatment for smoking cessation must be considered as a priority in allocating health resources. OBJETIVO Analisar os custos do Programa de Tratamento do Tabagismo no Sistema Único de Saúde e estimar o custo de sua implementação plena em um município brasileiro. MÉTODOS A abordagem intensiva e tratamento do tabagismo engloba consultas, sessões de terapia cognitivo-comportamental em grupo e uso de medicamentos. Os custos do atendimento e gerenciamento do programa foram estimados utilizando a metodologia do microcusteio. A implementação plena do programa no município de Goiânia, Goiás, foi definida como sua expansão para suprir a demanda de todos os fumantes motivados a parar de fumar no município que seriam atendidos pelo Sistema Único de Saúde. Foram considerados custos médicos e não médicos diretos: recursos humanos, medicamentos, material de consumo, despesas gerais, transporte, viagens, eventos e custos de capital. Foram incluídos custos dos níveis federal, estadual e municipal de gestão. A perspectiva da análise foi a do Sistema Único de Saúde. Análise de sensibilidade foi realizada variando parâmetros referentes à quantidade de atividades e aos recursos utilizados. As fontes de dados incluíram uma amostra de unidades de saúde da Atenção Primária, secretarias de saúde municipal e estadual e Ministério da Saúde. Os custos foram estimados em reais (R$) para o ano de 2010. RESULTADOS O custo do programa em Goiânia foi de R$429.079, sendo 78,0% referentes à abordagem e tratamento do tabagismo. O custo por paciente foi de R$534 e, por paciente que deixou de fumar, de R$1.435. A implementação plena do programa no município de Goiânia geraria custo de R$20,28 milhões, para atender 35.323 fumantes. CONCLUSÕES O Programa de Tratamento do Tabagismo tem bom desempenho em termos de custo por paciente que deixa de fumar. Tendo em vista a carga do tabagismo no Brasil, o tratamento para cessação de fumar deve ser considerado prioritário ao se programar a alocação de recursos de saúde.
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Affiliation(s)
- Andréa Cristina Rosa Mendes
- Departamento de Economia da Saúde, Investimentos e Desenvolvimento. Ministério da Saúde. Brasília, DF, Brasil
| | - Cristiana Maria Toscano
- Departamento de Saúde Coletiva. Instituto de Patologia Tropical e Saúde Pública. Universidade Federal de Goiás. Goiânia, GO, Brasil
| | | | - Alvaro Luis Pereira Ribeiro
- Departamento de Economia da Saúde, Investimentos e Desenvolvimento. Ministério da Saúde. Brasília, DF, Brasil
| | - Jonas Bohn Ritzel
- Departamento de Economia da Saúde, Investimentos e Desenvolvimento. Ministério da Saúde. Brasília, DF, Brasil
| | - Valéria de Souza Cunha
- Instituto Nacional de Câncer José Alencar Gomes da Silva. Ministério da Saúde. Rio de Janeiro, RJ, Brasil
| | - Bruce Bartholow Duncan
- Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
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Ku L, Brantley E, Bysshe T, Steinmetz E, Bruen BK. How Medicaid and Other Public Policies Affect Use of Tobacco Cessation Therapy, United States, 2010-2014. Prev Chronic Dis 2016; 13:E150. [PMID: 27788063 PMCID: PMC5084624 DOI: 10.5888/pcd13.160234] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION State Medicaid programs can cover tobacco cessation therapies for millions of low-income smokers in the United States, but use of this benefit is low and varies widely by state. This article assesses the effects of changes in Medicaid benefit policies, general tobacco policies, smoking norms, and public health programs on the use of cessation therapy among Medicaid smokers. METHODS We used longitudinal panel analysis, using 2-way fixed effects models, to examine the effects of changes in state policies and characteristics on state-level use of Medicaid tobacco cessation medications from 2010 through 2014. RESULTS Medicaid policies that require patients to obtain counseling to get medications reduced the use of cessation medications by approximately one-quarter to one-third; states that cover all types of cessation medications increased usage by approximately one-quarter to one-third. Non-Medicaid policies did not have significant effects on use levels. CONCLUSIONS States could increase efforts to quit by developing more comprehensive coverage and reducing barriers to coverage. Reductions in barriers could bolster smoking cessation rates, and the costs would be small compared with the costs of treating smoking-related diseases. Innovative initiatives to help smokers quit could improve health and reduce health care costs.
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Affiliation(s)
- Leighton Ku
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave, NW, 6th Floor, Washington, DC 20052.
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Huskamp HA, Greenfield SF, Stuart EA, Donohue JM, Duckworth K, Kouri EM, Song Z, Chernew ME, Barry CL. Effects of Global Payment and Accountable Care on Tobacco Cessation Service Use: An Observational Study. J Gen Intern Med 2016; 31:1134-40. [PMID: 27177915 PMCID: PMC5023596 DOI: 10.1007/s11606-016-3718-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/04/2016] [Accepted: 04/15/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Tobacco use is the leading cause of preventable death and disability. New payment and delivery system models including global payment and accountable care have the potential to increase use of cost-effective tobacco cessation services. OBJECTIVE To examine how the Alternative Quality Contract (AQC) established in 2009 by Blue Cross Blue Shield of Massachusetts (BCBSMA) has affected tobacco cessation service use. DESIGN We used 2006-2011 BCBSMA claims and enrollment data to compare adults 18-64 years in AQC provider organizations to adults in non-AQC provider organizations. We examined the AQC's effects on all enrollees; a subset at high risk of tobacco-related complications due to certain medical conditions; and behavioral health service users. MAIN MEASURES We examined use of: (1) any cessation treatment (pharmacotherapy or counseling); (2) varenicline or bupropion; (3) nicotine replacement therapies (NRTs); (4) cessation counseling; and (4) combination therapy (pharmacotherapy plus counseling). We also examined duration of pharmacotherapy use and number of counseling visits among users. KEY RESULTS Rates of tobacco cessation treatment use were higher following implementation of the AQC relative to the comparison group overall (2.02 vs. 1.87 %, p < 0.0001), among enrollees at risk for tobacco-related complications (4.97 vs. 4.66 %, p < 0.0001), and among behavioral health service users (3.67 vs. 3.25 %, p < 0.0001). Statistically significant increases were found for use of varenicline or bupropion alone, counseling alone, and combination therapy, but not for NRT use, pharmacotherapy duration, or number of counseling visits among users. CONCLUSIONS In its initial three years, the AQC was associated with increases in use of tobacco cessation services.
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Affiliation(s)
- Haiden A Huskamp
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA.
| | - Shelly F Greenfield
- McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | | | - Julie M Donohue
- University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | | | - Elena M Kouri
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
| | - Zirui Song
- Massachusetts General Hospital, Boston, MA, USA
| | - Michael E Chernew
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
| | - Colleen L Barry
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Vijayaraghavan M, Schroeder SA, Kushel M. The effectiveness of tobacco control policies on vulnerable populations in the USA: a review. Postgrad Med J 2016; 92:670-676. [DOI: 10.1136/postgradmedj-2014-133193] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 06/24/2016] [Accepted: 08/27/2016] [Indexed: 11/04/2022]
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Bhaumik U, Sommer SJ, Giller-Leinwohl J, Norris K, Tsopelas L, Nethersole S, Woods ER. Boston children's hospital community asthma initiative: Five-year cost analyses of a home visiting program. J Asthma 2016; 54:134-142. [PMID: 27624870 DOI: 10.1080/02770903.2016.1201837] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the costs and benefits of the Boston Children's Hospital Community Asthma Initiative (CAI) through reduction of Emergency Department (ED) visits and hospitalizations for the full pilot-phase program participants. METHODS A cost-benefit analyses was conducted using hospital administrative data to determine an adjusted Return on Investment (ROI): on all 268 patients enrolled in the CAI program during the 33-month pilot program phase of CAI intervention between October 1, 2005 and June 30, 2008 using a comparison group of 818 patients from a similar cohort in neighboring ZIP codes without CAI intervention. Cost data through June 30, 2013 were used to examine cost changes and calculate an adjusted ROI over a 5-year post-intervention period. RESULTS CAI patients had a cost reduction greater than the comparison group of $1,216 in Year 1 (P = 0.001), $1,320 in Year 2 (P < 0.001), $1,132 (P = 0.002) in Year 3, $1,123 (P = 0.004) in Year 4, and $997 (P = 0.022) in Year 5. Adjusting for the cost savings for the comparison group, the cost savings from the intervention resulted in an adjusted ROI of 1.91 over 5 years. CONCLUSIONS Community-based, multidisciplinary, coordinated disease management programs can decrease the incidence of costly hospitalizations and ED visits from asthma. An ROI of greater than one, as found in this cost analysis, supports the business case for the provision of community-based asthma services as part of patient-centered medical homes and Accountable Care Organizations.
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Affiliation(s)
- Urmi Bhaumik
- a Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston , MA , USA.,b Office of Community Health, Boston Children's Hospital , Boston , MA , USA
| | - Susan J Sommer
- a Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston , MA , USA
| | - Judith Giller-Leinwohl
- a Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston , MA , USA
| | - Kerri Norris
- c Department of Finance , Boston Children's Hospital , Boston , MA , USA
| | - Lindsay Tsopelas
- a Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston , MA , USA
| | - Shari Nethersole
- b Office of Community Health, Boston Children's Hospital , Boston , MA , USA.,d Division of General Pediatrics, Boston Children's Hospital , Boston , MA , USA
| | - Elizabeth R Woods
- a Division of Adolescent/Young Adult Medicine, Boston Children's Hospital , Boston , MA , USA
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