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Medicaid Coverage Expansions and Cigarette Smoking Cessation Among Low-income Adults

Koma, Jonathan W. BS*; Donohue, Julie M. PhD; Barry, Colleen L. PhD, MPP; Huskamp, Haiden A. PhD§; Jarlenski, Marian PhD, MPH

doi: 10.1097/MLR.0000000000000821
Original Articles

Introduction: Expanding Medicaid coverage to low-income adults may have increased smoking cessation through improved access to evidence-based treatments. Our study sought to determine if states’ decisions to expand Medicaid increased recent smoking cessation.

Methods: Using pooled cross-sectional data from the Behavioral Risk Factor Surveillance Survey for the years 2011–2015, we examined the association between state Medicaid coverage and the probability of recent smoking cessation among low-income adults without dependent children who were current or former smokers (n=36,083). We used difference-in-differences estimation to examine the effects of Medicaid coverage on smoking cessation, comparing low-income adult smokers in states with Medicaid coverage to comparable adults in states without Medicaid coverage, with ages 18–64 years to those ages 65 years and above. Analyses were conducted for the full sample and stratified by sex.

Results: Residence in a state with Medicaid coverage among low-income adult smokers ages 18–64 years was associated with an increase in recent smoking cessation of 2.1 percentage points (95% confidence interval, 0.25–3.9). In the comparison group of individuals ages 65 years and above, residence in a state with Medicaid coverage expansion was not associated with a change in recent smoking cessation (−0.1 percentage point, 95% confidence interval, −2.1 to 1.8). Similar increases in smoking cessation among those ages 18–64 years were estimated for females and males (1.9 and 2.2 percentage point, respectively).

Conclusion: Findings are consistent with the hypothesis that Medicaid coverage expansions may have increased smoking cessation among low-income adults without dependent children via greater access to preventive health care services, including evidence-based smoking cessation services.

*University Honors College, University of Pittsburgh

Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA

Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

§Department of Health Care Policy, Harvard Medical School, Boston, MA

Supported by the University of Pittsburgh Honors College Chancellor’s Research Fellowship to J.W.K., and the Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) Program (grant number K12HD043441) to M.J.

The authors declare no conflict of interest.

Reprints: Jonathan W. Koma, BS, 4350 East-West Highway, Suite 800, Bethesda, MD, 20814. E-mail:

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