State-specific smoking prevalence for the United States in 2001 ranged from 13.3% to 30.9% with Ohio’s rate at 27.7%, higher than the national average of 23.4% (CDC, 2003). Ohio had the fourth highest prevalence rate in the United States. In a survey of 99 metropolitan areas in the United States, Ohio claimed two of the four cities (Toledo and Cleveland-Lorain-Elyria) with the highest prevalence rates (CDC, 2001). The national median for smoking prevalence was 22.7% (range 13% - 31.2%). In a survey of Medicaid supported benefits for smoking cessation intervention, the prevalence of smoking nationally among the Medicaid population was approximately 50% higher than the national non-Medicaid smoking rate (CDC, 2001).
In April of 1998, Medicaid of Ohio began direct reimbursement for selected smoking cessation intervention pharmacotherapies including nicotine replacement and bupropion. Behavioral counseling and follow-up care were not included in the health benefits package. Very little was known about the impact of this policy change.
This study was a cross-sectional survey of Ohio’s Medicaid recipients who used smoking cessation pharmacotherapy during the period including January 1 through June 30, 1999. A telephone survey was used to collect detailed information from subjects related to the specific aims. The specific aims of the study were (1) to describe pertinent smoking history characteristics of individuals who filled prescriptions for smoking cessation pharmacotherapy reimbursed by Medicaid of Ohio from January 1, 1999 through June 30, 1999, and their smoking status 15-18 months post-intervention; and (2) to determine the effectiveness of Medicaid pharmacotherapy policy implementation among a subset of subjects who were treated for smoking cessation.
This study confirmed that smoking cessation pharmacotherapies provided by Medicaid of Ohio were as effective with this population as in the general public. In this study, a self-reported abstinence rate of 17.7% at 15-18 months post intervention follow-up was reported. The findings also demonstrated that interventions were effective for individuals participating in both TANF and ABD programs. Fewer friends who smoke, was found to predict abstinence from smoking after intervention. Policy implications are presented related to implementation of the AHRQ clinical practice guideline for smoking cessation intervention.