Brady Benjamin R, O'Connor Patrick A, Martz Mark P, Grogg Taylor, Nair Uma S
Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., P.O. Box 245210, Tucson, AZ, 85724, USA.
Arizona Center for Tobacco Cessation in the Department of Health Promotion Science, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
J Behav Health Serv Res. 2022 Jan;49(1):61-75. doi: 10.1007/s11414-021-09756-2. Epub 2021 May 4.
Medicaid-insured individuals who smoke experience disparities in quitting and are a priority population for assistance. This retrospective cohort study of Arizona Smokers' Helpline clients (Jan 2014-Mar 2019) examined the association between insurance status, treatment, and smoking cessation. When compared to clients with non-Medicaid insurance or no insurance, clients with Medicaid (26%) were more likely to be female, referred directly to the ASHLine by a healthcare or community partner, smoke in the home, and report having a mental health condition. They also were less likely to utilize cessation medication and reported receiving less social support to quit. Controlling for these and other theoretically relevant variables, insurance status was stratified (Medicaid, non-Medicaid, and uninsured), and quit outcomes were compared by level of treatment (4 treatment groups: more and less than 3 coaching sessions and cessation medication use yes/no). Compared to clients who received 3+ coaching sessions, those who had less than 3 coaching sessions had significantly lower adjusted odds of quitting. Results were similar regardless of cessation medication use or insurance status. There is no indication that treatment effects differ by insurance status. While insurance status appears to proxy for other important factors like low social and economic status and higher comorbidity prevalence, in a quitline setting, quitting is associated with additional, high-quality coaching. Where coaching sessions may offset social and economic barriers to quitting, quitlines may consider focusing on assisting Medicaid-insured clients to connect and engage with treatment.
参加医疗补助保险的吸烟者在戒烟方面存在差异，是需要援助的重点人群。这项对亚利桑那州吸烟者热线客户（2014年1月至2019年3月）的回顾性队列研究，考察了保险状况、治疗与戒烟之间的关联。与参加非医疗补助保险或无保险的客户相比，参加医疗补助保险的客户（26%）更有可能为女性，由医疗保健或社区合作伙伴直接转介至吸烟者热线，在家中吸烟，并报告患有精神健康疾病。他们也较少可能使用戒烟药物，且报告称在戒烟方面获得的社会支持较少。在控制这些及其他理论上相关的变量后，对保险状况进行分层（医疗补助保险、非医疗补助保险和无保险），并按治疗水平比较戒烟结果（4个治疗组：辅导课程多于和少于3次以及是否使用戒烟药物）。与接受3次及以上辅导课程的客户相比，接受辅导课程少于3次的客户经调整后的戒烟几率显著较低。无论是否使用戒烟药物或保险状况如何，结果均相似。没有迹象表明治疗效果因保险状况而异。虽然保险状况似乎代表了其他重要因素，如社会经济地位低和合并症患病率高，但在戒烟热线环境中，戒烟与额外的高质量辅导相关。在辅导课程可能抵消戒烟的社会和经济障碍的情况下，戒烟热线可考虑专注于协助参加医疗补助保险的客户与治疗建立联系并参与治疗。
