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

描述(申请人提供)：这项研究的目标是研究2000至2010年间美国各州的医疗补助政策如何影响怀孕期间的吸烟状况、怀孕期间戒烟服务的使用以及婴儿的健康结果。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的妇女产前吸烟流行率是参加私人保险的妇女的两倍多。怀孕为促进戒烟提供了一个干预的机会，近年来，各州已经采取措施，促进怀孕早期的医疗补助登记，并提高医疗补助中戒烟服务的覆盖面。然而，关于州医疗补助计划中登记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，人们知之甚少。这项研究的目标1将利用国家动态医疗保健调查的数据，描述在全国范围内参加医疗补助的妇女在怀孕期间使用咨询和药物疗法戒烟的情况。目的2，使用怀孕风险评估监测系统来自37个地点的数据，将评估两项可选的州医疗补助登记政策的影响，以促进早期开始产前护理对怀孕期间吸烟状况和出生结果的影响。目标2还将调查这些登记政策的影响是否被各州戒烟服务覆盖面的全面性所改变。AIM 3使用来自医疗补助管理保健组织的管理数据，将检查参加医疗补助的妇女在第一次怀孕期间吸烟的妇女在随后怀孕期间使用戒烟服务的强度是否发生变化，以及第一次怀孕期间出现与吸烟相关的并发症是否预示着戒烟服务的使用增加。研究结果将提供证据，说明州医疗补助计划的登记和服务交付政策如何最好地促进产前护理期间戒烟。在为期两年的奖项中，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；并完成这篇论文的研究项目。研究和培训经验将使Jarlenski女士能够实现她的职业目标，即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.