ArticleSubstance abuse treatment, prevention, and policy2020
Appalachian disparities in tobacco cessation treatment utilization in Medicaid.
Article in Substance abuse treatment, prevention, and policy, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Constructing Directed Acyclic Graphs (DAGs) to Inform Tobacco Cessation Intervention Research: A Methodological Extension Using Evidence Synthesis.Healthcare (Basel, Switzerland) · 2025Article
- Geographic Representativeness of a Digital Tobacco Cessation Intervention: An Exploration of Changes in Rural Reach From 2013-2020.Tobacco use insights · 2025Article
- Participation in Tobacco Cessation Programs Among Medicaid Managed Care Enrollees in Florida.Healthcare (Basel, Switzerland) · 2024Article
- Description of a Lung Cancer Hotspot: Disparities in Lung Cancer Histology, Incidence, and Survival in Kentucky and Appalachian Kentucky.Clinical lung cancer · 2021Article
- Hemorrhagic stroke outcomes of KApSR patients with co-morbid diabetes and Alzheimer's disease.Annals of translational medicine · 2021Article
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Authors and funding
5 authors.
Funding
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Abstract
backgroundKentucky Medicaid enrollees, particularly those in the rural Appalachian region, face disproportionate smoking rates and tobacco-related disease burden relative to the rest of the United States (US). The Affordable Care Act (ACA) mandated tobacco cessation treatment coverage by the US public health insurance program Medicaid. Medicaid coverage was also expanded in Kentucky, in 2013, with laxer income eligibility requirements. This short report describes tobacco use incidence and tobacco cessation treatment utilization, comparing by Appalachian status before and after ACA-mandated cessation treatment coverage.
methodsThe study design was a retrospective cross-sectional analysis from 2013 to 2015. Subjects were Medicaid enrollees with 1) diagnosis of any tobacco use (2013 n = 541,349; 2014 n = 864,183; 2015 n = 1,090,274); and/or (2) procedure claim for tobacco cessation counseling, and/or (3) pharmaceutical claim for varenicline or any nicotine replacement product. Primary measures included tobacco use incidence and proportion of users receiving cessation treatment. Analysis was via chi square testing of change by year.
resultsOverall, the proportion of tobacco users utilizing cessation treatment decreased (4.75% tobacco users in 2013; 3.15% in 2015). Tobacco users receiving counseling decreased from 2.06% pre-ACA (2013) to 1.06% post-ACA (2015, p < 0.001), as did the proportion receiving nicotine replacement products post-ACA (2.69% in 2013 to 1.55% by 2015; p < 0.001). More Appalachians received cessation treatment than non-Appalachians in 2013 (2.72% vs. 2.03%), but by 2015 non-Appalachians received more treatment overall (1.50% vs. 1.65%; p < 0.001). Appalachians received more counseling and NRT, but less varenicline, than non-Appalachians.
conclusionsUtilization of all forms of tobacco cessation treatment throughout Kentucky, and particularly in rural Appalachia, remained limited despite Medicaid enrollment as well as coverage expansions. These findings suggest that barriers persist in access to tobacco cessation treatment for individuals in Medicaid.
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