Background: 40% of births in the USA are covered by Medicaid and smoking is prevalent among recipients. The objective of this study was to evaluate the association between levels of Medicaid coverage for prenatal smoking cessation interventions on quitting during pregnancy and maintaining cessation after delivery.
Methods: Population based survey study of 7513 post-partum women from 15 states who: participated in Pregnancy Risk Assessment Monitoring System (PRAMS) during 1998–2000; smoked at the beginning of their pregnancy; and had Medicaid coverage. Participating states were categorised into three levels of Medicaid coverage for smoking cessation interventions during prenatal care: extensive (pharmacotherapies and counselling); some (pharmacotherapies or counselling); or none. Quit rates among women who smoked before pregnancy and rates of maintaining cessation were examined.
Results: Higher levels of coverage during prenatal care for smoking cessation interventions were associated with higher quit rates; 51%, 43%, and 39% of women quit in states with extensive, some, and no coverage, respectively. Compared to women in states with no coverage, women in states with extensive coverage had 1.6 times the odds of quitting smoking (odds ratio (OR) 1.58, 95% confidence interval (CI) 1.00 to 2.49). Maintenance of cessation after delivery was associated with extensive levels of Medicaid coverage; 48% of women maintained cessation in states with extensive coverage compared to 37% of women in states with no coverage. Compared to women in states with no coverage, women with extensive coverage had 1.6 times the odds of maintaining cessation (OR 1.63, 95% CI 1.04 to 2.56).
Conclusions: Prenatal Medicaid coverage for both pharmacotherapies and counselling is associated with higher rates of quitting and continued cessation. This suggests policymakers can promote cessation by broadening smoking cessation services in Medicaid prenatal coverage.
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↵§ Department of Maternal and Child Health, School of Public Health, University of North Carolina at Chapel Hill
↵* Also Center for Women’s Health Research, and Cecil Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
↵† Also Center for Women’s Health Research, University of North Carolina at Chapel Hill
↵‡ Also Center for Women’s Health Research, Cecil Sheps Center for Health Services Research, and Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill
Competing interests: none declared
Human participation protection: This project was reviewed by the Committee on the Protection of the Rights of Human Subjects at the University of North Carolina at Chapel Hill and was found to be exempt from review since subjects could not be identified from the secondary data source used in this analysis (per number 4 in 45 CFR Part 46 Section 101).
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