Table 2.
Association between implementation of smoking cessation services and primary outcomes
| Details of intervention | Population at risk (n) | Events (n) | Slope before intervention (% change in events per year) | Direct change in events (step change, %; 95% CI) | Sustained change in events per year (slope change, %; 95% CI) | Summary of findings | |
|---|---|---|---|---|---|---|---|
| Preterm birth | |||||||
| Jarlenski (2014)47 | State adoption of one of two optional Medicaid enrolment policies, allowing more low-income pregnant women to receive prenatal care, including smoking cessation services (presumptive eligibility and the unborn child option)* | 24 544 | NR | NR | Overall: −1·4%§ (−4·7 to 2·0)Comprehensive: −2·2%§ (−5·9 to 1·5)Non-comprehensive: 1·3%§ (−2·4 to 5·1) | NA | Neither optional Medicaid enrolment policy was associated with significant changes in preterm birth |
| Asthma exacerbations requiring hospital attendance | |||||||
| Hawkins (2016)18 | Health reform legislation that provided counselling for smoking cessation and tobacco cessation treatment to Medicaid recipients | NR | 112 808 | NR | 2% (−4 to 8) | NA | The state-wide health reform legislation in MA, USA, was not associated with significant changes in emergency department visits for asthma |
| Upper RTI admissions | |||||||
| Hawkins (2016)18 | Health reform legislation that provided counselling for smoking cessation and tobacco cessation treatment to Medicaid recipients | NR | 337 628 | NR | −6% (−10 to −1) | NA | The state-wide health reform legislation in MA, USA, was associated with a 6% decrease in emergency department visits for upper RTIs |
| Lower RTI admissions | |||||||
| Hawkins (2016)18 | Health reform legislation that provided counselling for smoking cessation and tobacco cessation treatment to Medicaid recipients | NR | 113 137 | NR | 0% (−6 to 6) | NA | The state-wide health reform legislation in MA, USA, was not associated with significant changes in emergency department visits for lower RTIs |
NR=not reported. NA=not applicable. RTI=respiratory tract infection.
*
Presumptive eligibility: low-income pregnant women are presumed to be eligible for Medicaid, so they can receive care (including smoking cessation services) while their Medicaid applications are still pending. The unborn-child option: the state can consider a fetus a “targeted low-income child”, allowing coverage of prenatal care (including smoking cessation services) and delivery to low-income pregnant women, even if they cannot provide documentation of citizenship or residency.