Effects of State Medicaid Policies On Prenatal Smoking and Infant Health Outcomes

描述（由申请人提供）：本研究的目的是研究2000年至2010年间美国国家医疗补助政策如何影响怀孕期间吸烟状况、怀孕期间戒烟服务的使用和婴儿健康结果。怀孕期间吸烟仍然是导致孕产妇和婴儿健康状况不佳的最重要的可改变原因之一，参加医疗补助计划的妇女的产前吸烟率是参加私人保险的妇女的两倍多。怀孕提供了一个干预促进戒烟的机会，近年来，各州已采取措施促进怀孕早期的医疗补助登记，并提高医疗补助戒烟服务的覆盖率。然而，关于州医疗补助计划的注册或服务提供政策的这些变化如何影响产前吸烟状况和婴儿健康结果，我们知之甚少。使用来自国家门诊医疗调查的数据，研究的目的1将描述在全国范围内参加医疗补助计划的妇女在怀孕期间戒烟的咨询和药物治疗的使用情况。目标2使用来自37个站点的妊娠风险评估监测系统的数据，将评估两项可选的州医疗补助登记政策的效果，以促进怀孕期间吸烟状况和分娩结果的早期产前护理。目标2还将调查这些登记政策的效果是否会因各州戒烟服务覆盖的全面性而有所改变。目的3，使用来自医疗补助管理组织的管理数据，将检查在医疗补助中登记的首次怀孕吸烟的妇女在随后的怀孕中戒烟服务的使用强度是否会发生变化，以及首次怀孕中吸烟相关并发症的存在是否预示着戒烟服务的使用增加。研究结果将为州医疗补助计划的注册和服务提供政策如何在产前护理期间最好地促进戒烟提供证据。在为期两年的奖励期间，Jarlenski女士将完成数据管理、烟草控制和流行病学方面的课程；与教师导师一起寻求研究和出版机会；并完成本论文的研究课题。研究和培训经验将使Jarlenski女士能够实现她的职业目标，成为一名独立调查员，进行创新研究，以减少医疗补助人群怀孕期间的烟草使用。

DESCRIPTION (provided by applicant): The objective of this research is to study how state Medicaid policies affected smoking status during pregnancy, use of smoking cessation services during pregnancy, and infant health outcomes in the U.S. between 2000 and 2010. Tobacco use during pregnancy remains one of the most important modifiable causes of poor maternal and infant health outcomes, and women enrolled in Medicaid have more than twice the prenatal smoking prevalence of women enrolled in private insurance. Pregnancy presents an opportunity to intervene to promote smoking cessation, and in recent years, states have taken steps to promote Medicaid enrollment early in pregnancy and to improve coverage of smoking cessation services in Medicaid. Little is known, however, about how these changes to enrollment or service-delivery policies in state Medicaid programs have affected prenatal smoking status and infant health outcomes. Using data from the National Ambulatory Medical Care Survey, Aim 1 of the research will describe use of counseling and pharmacotherapy for smoking cessation during pregnancy among Medicaid- enrolled women nationally. Aim 2, using data from the Pregnancy Risk Assessment Monitoring System from 37 sites, will evaluate the effects of two optional state Medicaid enrollment policies to promote early initiation of prenatal care on smoking status during pregnancy and birth outcomes. Aim 2 will also investigate whether the effects of these enrollment policies are modified by the comprehensiveness of states' coverage of smoking cessation services. Aim 3, using administrative data from a Medicaid managed-care organization, will examine whether intensity of use of smoking cessation services changes over subsequent pregnancies among women enrolled in Medicaid who smoked during their first pregnancy, and if the presence of smoking-related complications in the first pregnancy is predictive of increased use of smoking cessation services. Research findings will provide evidence about how enrollment and service- delivery polices in state Medicaid programs can best promote smoking cessation during prenatal care. During the two-year award, Ms. Jarlenski will complete coursework in data management, tobacco control, and epidemiology; pursue research and publication opportunities with faculty mentors; and complete this dissertation research project. The research and training experiences will enable Ms. Jarlenski to achieve her career goal of becoming an independent investigator conducting innovative research to reduce tobacco use during pregnancy in the Medicaid population.