Medicaid Coverage for Tobacco Dependence Treatments in Massachusetts and Associated Decreases in Smoking Prevalence
Medicaid Coverage for Tobacco Dependence Treatments in Massachusetts and Associated Decreases in Smoking Prevalence
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DOI：
10.1371/journal.pone.0009770
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发表时间：
2010-03-18
期刊：
影响因子：
3.7
通讯作者：
Keithly, Lois
中科院分区：
文献类型：
--
作者：
Land, Thomas;Warner, Donna;Keithly, Lois
背景：大约50%的吸烟者过早死于烟草相关疾病。2006年7月，马萨诸塞州医疗改革法强制规定马萨诸塞州医疗补助人口戒烟。新的福利包括行为咨询和美国政府批准的所有戒烟治疗药物。S.美国食品药品监督管理局（FDA）。在2006年7月1日至2008年12月31日期间，共有70,140名独特的马萨诸塞州医疗补助订户使用了这项新的福利，约占所有马萨诸塞州医疗补助吸烟者的37%。鉴于高利用率，本研究的目的是确定吸烟率是否显着下降后，开始戒烟coverage.Methods和调查结果：吸烟率进行了评估前至后的好处，通过2008年的数据从马萨诸塞州行为风险因素调查（BRFSS）。粗吸烟率从38.3%（95%C. I. 33.6%-42.9%），而受益前的28.3%（95% C。一、：24.0%-32.7%），下降了26%。人口统计学调整后的吸烟率显示出类似的下降后的利益时期。趋势分析反映出流行率随着时间的推移而逐渐下降。具体而言，对1999年至2008年马萨诸塞州符合医疗补助福利条件的成员（18-64岁）的吸烟率进行的联合点分析发现，随着福利的实施，吸烟率呈下降趋势。最后，控制人口统计学因素的Logistic回归也显示，从2006年7月1日到2008年12月31日，吸烟趋势显著下降。结论：这些发现表明，包括药物和行为治疗在内的戒烟福利，获得障碍少，涉及广泛的宣传，可以显着降低吸烟率。
Background: Approximately 50% of smokers die prematurely from tobacco-related diseases. In July 2006, the Massachusetts health care reform law mandated tobacco cessation coverage for the Massachusetts Medicaid population. The new benefit included behavioral counseling and all medications approved for tobacco cessation treatment by the U. S. Food and Drug Administration (FDA). Between July 1, 2006 and December 31, 2008, a total of 70,140 unique Massachusetts Medicaid subscribers used the newly available benefit, which is approximately 37% of all Massachusetts Medicaid smokers. Given the high utilization rate, the objective of this study is to determine if smoking prevalence decreased significantly after the initiation of tobacco cessation coverage.Methods and Findings: Smoking prevalence was evaluated pre- to post-benefit using 1999 through 2008 data from the Massachusetts Behavioral Risk Factor Survey (BRFSS). The crude smoking rate decreased from 38.3% (95% C. I. 33.6%-42.9%) in the pre-benefit period compared to 28.3% (95% C. I.: 24.0%-32.7%) in the post-benefit period, representing a decline of 26 percent. A demographically adjusted smoking rate showed a similar decrease in the post-benefit period. Trend analyses reflected prevalence decreases that accrued over time. Specifically, a joinpoint analysis of smoking prevalence among Massachusetts Medicaid benefit-eligible members (age 18-64) from 1999 through 2008 found a decreasing trend that was coincident with the implementation of the benefit. Finally, a logistic regression that controlled for demographic factors also showed that the trend in smoking decreased significantly from July 1, 2006 to December 31, 2008.Conclusion: These findings suggest that a tobacco cessation benefit that includes coverage for medications and behavioral treatments, has few barriers to access, and involves broad promotion can significantly reduce smoking prevalence.