Effect of Gaining Insurance Coverage on Smoking Cessation in Community Health Centers

A Cohort Study

Steffani Bailey, Megan J. Hoopes, Miguel Marino, John Heintzman, Jean P. O’Malley, Brigit Hatch, Heather Angier, Stephen P. Fortmann, Jennifer Devoe

Research output: Contribution to journalArticle

16 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalJournal of General Internal Medicine
DOIs
StateAccepted/In press - Jun 21 2016

Fingerprint

Community Health Centers
Insurance Coverage
Smoking Cessation
Cohort Studies
Smoking
Medicaid
Vulnerable Populations
Smoke
Patient Protection and Affordable Care Act
Propensity Score
Electronic Health Records
Observational Studies
Primary Health Care

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Effect of Gaining Insurance Coverage on Smoking Cessation in Community Health Centers : A Cohort Study. / Bailey, Steffani; Hoopes, Megan J.; Marino, Miguel; Heintzman, John; O’Malley, Jean P.; Hatch, Brigit; Angier, Heather; Fortmann, Stephen P.; Devoe, Jennifer.

In: Journal of General Internal Medicine, 21.06.2016, p. 1-8.

Research output: Contribution to journalArticle

@article{7ef00674329c452bb3900164cf9f93e4,
title = "Effect of Gaining Insurance Coverage on Smoking Cessation in Community Health Centers: A Cohort Study",
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.",
author = "Steffani Bailey and Hoopes, {Megan J.} and Miguel Marino and John Heintzman and O’Malley, {Jean P.} and Brigit Hatch and Heather Angier and Fortmann, {Stephen P.} and Jennifer Devoe",
year = "2016",
month = "6",
day = "21",
doi = "10.1007/s11606-016-3781-4",
language = "English (US)",
pages = "1--8",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer New York",

}

TY - JOUR

T1 - Effect of Gaining Insurance Coverage on Smoking Cessation in Community Health Centers

T2 - A Cohort Study

AU - Bailey, Steffani

AU - Hoopes, Megan J.

AU - Marino, Miguel

AU - Heintzman, John

AU - O’Malley, Jean P.

AU - Hatch, Brigit

AU - Angier, Heather

AU - Fortmann, Stephen P.

AU - Devoe, Jennifer

PY - 2016/6/21

Y1 - 2016/6/21

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84975299468&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84975299468&partnerID=8YFLogxK

U2 - 10.1007/s11606-016-3781-4

DO - 10.1007/s11606-016-3781-4

M3 - Article

SP - 1

EP - 8

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

ER -