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01-10-2016 | Original Research

Effect of Gaining Insurance Coverage on Smoking Cessation in Community Health Centers: A Cohort Study

Authors: Steffani R. Bailey, PhD, Megan J. Hoopes, MPH, Miguel Marino, PhD, John Heintzman, MD, MPH, Jean P. O’Malley, MPH, Brigit Hatch, MD, Heather Angier, MPH, Stephen P. Fortmann, MD, Jennifer E. DeVoe, MD DPhil

Published in: Journal of General Internal Medicine | Issue 10/2016

ABSTRACT

BACKGROUND

Community health center (CHC) patients have high rates of smoking. Insurance coverage for smoking cessation assistance, such as that mandated by the Affordable Care Act, may aid in smoking cessation in this vulnerable population.

OBJECTIVE

We aimed to determine if uninsured CHC patients who gain Medicaid coverage experience greater primary care utilization, receive more cessation medication orders, and achieve higher quit rates, compared to continuously uninsured smokers.

DESIGN

Longitudinal observational cohort study using electronic health record data from a network of Oregon CHCs linked to Oregon Medicaid enrollment data.

PATIENTS

Cohort of patients who smoke and who gained Medicaid coverage in 2008–2011 after ≥ 6 months of being uninsured and with ≥ 1 smoking assessment in the 24-month follow-up period from the baseline smoking status date. This group was propensity score matched to a cohort of continuously uninsured CHC patients who smoke (n = 4140 matched pairs; 8280 patients).

INTERVENTION

Gaining Medicaid after being uninsured for ≥ 6 months.

MAIN MEASURES

‘Quit’ smoking status (baseline smoking status was ‘current every day’ or ‘some day’ and status change to ‘former smoker’ at a subsequent visit), smoking cessation medication order, and ≥ 6 documented visits (yes/no variables) at ≥ 1 smoking status assessment within the 24-month follow-up period.

KEY RESULTS

The newly insured had 40 % increased odds of quitting smoking (aOR = 1.40, 95 % CI:1.24, 1.58), nearly triple the odds of having a medication ordered (aOR = 2.94, 95 % CI:2.61, 3.32), and over twice the odds of having ≥ 6 follow-up visits (aOR = 2.12, 95 % CI:1.94, 2.32) compared to their uninsured counterparts.

CONCLUSIONS

Newly insured patients had increased odds of quit smoking status over 24 months of follow-up than those who remained uninsured. Providing insurance coverage to vulnerable populations may have a significant impact on smoking cessation.

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Title: Effect of Gaining Insurance Coverage on Smoking Cessation in Community Health Centers: A Cohort Study
Authors: Steffani R. Bailey, PhD
Megan J. Hoopes, MPH
Miguel Marino, PhD
John Heintzman, MD, MPH
Jean P. O’Malley, MPH
Brigit Hatch, MD
Heather Angier, MPH
Stephen P. Fortmann, MD
Jennifer E. DeVoe, MD DPhil
Publication date: 01-10-2016
Publisher: Springer US
Published in: Journal of General Internal Medicine / Issue 10/2016
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-016-3781-4

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Effect of Gaining Insurance Coverage on Smoking Cessation in Community Health Centers: A Cohort Study

ABSTRACT

BACKGROUND

OBJECTIVE

DESIGN

PATIENTS

INTERVENTION

MAIN MEASURES

KEY RESULTS

CONCLUSIONS

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ABSTRACT

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PATIENTS

INTERVENTION

MAIN MEASURES

KEY RESULTS

CONCLUSIONS

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