This application for an R15 Area Research Enhancement Award (AREA) is designed to examine the effectiveness of state Medicaid tobacco cessation policies. Tobacco use is the leading preventable cause of death and of cancer in the United States. Recent research demonstrates that a robust state program can lead to lower smoking rates, reduced cardiovascular hospitalizations and save $3 in hospital costs for every $1 invested. The three specific aims are: (1) to develop and analyze new data about the utilization of Medicaid tobacco cessation treatments at state levels from 2003 to 2011, based on Medicaid drug rebate files, and to link these to other state tobacco control and Medicaid policies, (2) to assess factors related to higher Medicaid treatment utilization using mixed mode research, including pooled time series panel analysis across the nation and case studies of six states, and (3) to examine the relationship between changes in states'Medicaid treatment utilization and other state policies with individual-level behaviors, including overall smoking prevalence and quit rates, using the 2003, 2006-7 and 2010-11 Tobacco Use Supplements of the Current Population Survey. The findings will provide better insights into Medicaid tobacco cessation efforts and the factors that lead to more effective policies. In keeping with the goals of AREA grants, students will be integral to the research process;the co-investigator is a mid-career PhD student and another graduate student will be supported. Analyses from this project will also be incorporated into the statistics course work, exposing a much larger number of students to the research. Our school has had relatively few NIH grants and receipt of this grant will help build our ability to conduct and compete for NIH- funded academic research.
Low-income Medicaid beneficiaries are much more likely to smoke than the general population and the number of adult Medicaid beneficiaries is expected to surge. Understanding factors that lead to more effective tobacco cessation policies in Medicaid can contribute to the development of stronger state policies. These could improve health by reducing tobacco use in a high risk population and help contain health care costs.