Medicaid reimbursement for prenatal smoking intervention influences quitting and cessation
Medicaid reimbursement for prenatal smoking intervention influences quitting and cessation
复制标题
产前吸烟干预的医疗补助报销影响戒烟和戒烟
作者：
R. Petersen;J. Garrett;C. Melvin;K. Hartmann
背景：在美国，40%的新生儿都在医疗补助计划的覆盖范围内，而吸烟在接受者中很普遍。本研究的目的是评估医疗补助覆盖水平之间的关联，产前戒烟干预措施在怀孕期间戒烟和分娩后保持戒烟。研究方法：对来自15个州的7513名产后妇女进行了基于人口的调查研究，这些妇女在1998-2000年期间参加了妊娠风险评估监测系统（PRAMS）;在怀孕初期吸烟;并有医疗补助。参与国家分为三个层次的医疗补助覆盖范围戒烟干预产前护理：广泛（药物治疗和咨询）;一些（药物治疗或咨询）;或没有。研究了怀孕前吸烟的妇女的戒烟率和保持戒烟的比率。结果如下：产前护理戒烟干预的覆盖率较高与戒烟率较高相关;在广泛覆盖、部分覆盖和无覆盖的州，分别有51%、43%和39%的妇女戒烟。与没有覆盖的州的妇女相比，覆盖广泛的州的妇女戒烟的几率是1.6倍（比值比（OR）1.58，95%置信区间（CI）1.00至2.49）。分娩后维持戒烟与医疗补助覆盖范围的广泛程度有关;在覆盖范围广泛的州，48%的妇女保持戒烟，而在没有覆盖的州，37%的妇女保持戒烟。与没有覆盖的州的妇女相比，有广泛覆盖的妇女维持戒烟的几率是1.6倍（OR 1.63，95%CI 1.04至2.56）。结论：产前药物治疗和咨询的医疗补助覆盖率与较高的戒烟率和持续戒烟率相关。这表明政策制定者可以通过扩大医疗补助产前覆盖范围中的戒烟服务来促进戒烟。
Background: 40% of births in the USA are covered by Medicaid and smoking is prevalent among recipients. The objective of this study was to evaluate the association between levels of Medicaid coverage for prenatal smoking cessation interventions on quitting during pregnancy and maintaining cessation after delivery. Methods: Population based survey study of 7513 post-partum women from 15 states who: participated in Pregnancy Risk Assessment Monitoring System (PRAMS) during 1998–2000; smoked at the beginning of their pregnancy; and had Medicaid coverage. Participating states were categorised into three levels of Medicaid coverage for smoking cessation interventions during prenatal care: extensive (pharmacotherapies and counselling); some (pharmacotherapies or counselling); or none. Quit rates among women who smoked before pregnancy and rates of maintaining cessation were examined. Results: Higher levels of coverage during prenatal care for smoking cessation interventions were associated with higher quit rates; 51%, 43%, and 39% of women quit in states with extensive, some, and no coverage, respectively. Compared to women in states with no coverage, women in states with extensive coverage had 1.6 times the odds of quitting smoking (odds ratio (OR) 1.58, 95% confidence interval (CI) 1.00 to 2.49). Maintenance of cessation after delivery was associated with extensive levels of Medicaid coverage; 48% of women maintained cessation in states with extensive coverage compared to 37% of women in states with no coverage. Compared to women in states with no coverage, women with extensive coverage had 1.6 times the odds of maintaining cessation (OR 1.63, 95% CI 1.04 to 2.56). Conclusions: Prenatal Medicaid coverage for both pharmacotherapies and counselling is associated with higher rates of quitting and continued cessation. This suggests policymakers can promote cessation by broadening smoking cessation services in Medicaid prenatal coverage.
影响因子：
5
作者：
M. Klebanoff;Richard J. Levine;J. Clemens;R. Dersimonian;D. Wilkins
通讯作者：
M. Klebanoff;Richard J. Levine;J. Clemens;R. Dersimonian;D. Wilkins
DOI：
10.1001/jama.1993.03500120057026
发表时间：
1993-03
期刊：
JAMA
影响因子：
--
作者：
C. Li;R. Windsor;L. Perkins;Robert L. Goldenberg;J. Lowe
通讯作者：
C. Li;R. Windsor;L. Perkins;Robert L. Goldenberg;J. Lowe