John T. Milliken Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri; Health Communication Research Laboratory, Washington University Brown School, St. Louis, Missouri.
Health Communication Research Laboratory, Washington University Brown School, St. Louis, Missouri.
Am J Prev Med. 2023 Feb;64(2):227-234. doi: 10.1016/j.amepre.2022.09.008. Epub 2022 Nov 3.
Smoking rates differ by insurance type; rates are often double for Medicaid and uninsured compared with that for Medicare or privately insured. State-funded tobacco quitlines' provision of free nicotine replacement therapy varies. In some states, Medicaid beneficiaries must obtain nicotine replacement therapy from a physician, whereas others get nicotine replacement therapy mailed to them.
This secondary analysis examined the differences in the source and use of cessation treatment by insurance type and their impacts on cessation. The parent trial excluded people who were pregnant, had private insurance, or were not ready to quit. From June 1, 2017 to November 15, 2020, a total of 1,944 low-income people who smoke daily completed a baseline survey and were enrolled in a quitline program; 1,380 (71%) completed a 3-month follow-up. Analyses were completed in August 2022. Participants were classified as Medicaid/dual (55%), Medicare/Veterans Affairs (14%), or uninsured (31%). Nine months into the trial, owing to a system error, the quitline provided nicotine replacement therapy to all study participants regardless of insurance type.
Before error versus after error, Medicaid participants reported lower nicotine replacement therapy receipt (3.2% vs 50.8%) and use (32.4% vs 52.6%). The odds of quitting (7-day point prevalence) by 3 months increased for people who smoke who completed more quitline calls and used any (36% quit) versus used no (20% quit) pharmacotherapy, but quitting did not differ by insurance classifications (27%-29%). Getting and using nicotine replacement therapy from the quitline produced the highest quit rates (38%).
Results illustrate the benefit of receiving nicotine replacement therapy from the quitline on cessation. Mailing nicotine replacement therapy to all people who smoke should be standard practice to reduce smoking disparities.
不同保险类型的吸烟率不同；与医疗保险或私人保险相比，医疗补助和无保险的吸烟率往往高出一倍。由州资助的戒烟热线提供的免费尼古丁替代疗法各不相同。在一些州，医疗补助受益人必须从医生那里获得尼古丁替代疗法，而其他州则将尼古丁替代疗法邮寄给他们。
这项二次分析研究了不同保险类型的戒烟治疗的来源和使用差异，以及它们对戒烟的影响。该试验的主要研究对象排除了怀孕、有私人保险或尚未准备好戒烟的人群。从 2017 年 6 月 1 日至 2020 年 11 月 15 日，共有 1944 名低收入每日吸烟者完成了基线调查并被纳入戒烟热线项目；其中 1380 人（71%）完成了 3 个月的随访。分析于 2022 年 8 月完成。参与者被分为医疗补助/双重保险（55%）、医疗保险/退伍军人事务部（14%）或无保险（31%）。试验进行到 9 个月时，由于系统错误，无论保险类型如何，戒烟热线都向所有研究参与者提供尼古丁替代疗法。
在系统错误之前和之后，医疗补助参与者报告的尼古丁替代疗法使用率（3.2%比 50.8%）和使用量（32.4%比 52.6%）较低。完成更多戒烟热线电话拨打和使用任何（36%戒烟）而不使用任何（20%戒烟）药物治疗的吸烟者在 3 个月时戒烟的可能性增加，但戒烟与保险分类无关（27%-29%）。从戒烟热线获得和使用尼古丁替代疗法产生的戒烟率最高（38%）。
结果表明，从戒烟热线获得尼古丁替代疗法对戒烟有好处。向所有吸烟者邮寄尼古丁替代疗法应该成为减少吸烟差异的标准做法。
