Uninsured And Medicaid Oregon Tobacco User Experience
Article Highlights
- Study Title
- The Uninsured and Medicaid Oregon tobacco user experience in a real world, phone based cessation program
- Study Authors
- AY El-Bastawissi, Tim McAfee, Susan M. Zbikowski, et al.
- Publication Date
- 2003
- Complete Study
- View Complete Abstract
Most information on the effectiveness of tobacco cessation programs for people who are uninsured or using Medicaid is found in the fields of medical and public health research. This study, on the other hand, gathers information on the real world experience of tobacco users in the cessation program, Free & Clear.
Design
Tobacco users from Oregon who enrolled in Free & Clear between November 1998 and February 2000 were participants in this study. The researchers identified them through F&C's database and followed their progress for 12 months post-registration to assess their success at quitting tobacco.
Specifically, the study examined how successful participants were at quitting tobacco and how their success correlated to the following factors: number of calls completed with F&C, insurance status, and amount of co-pay required by insurance company. To organize the findings by insurance status, the researchers divided participants into three groups based on their status at enrollment: uninsured, Medicaid recipients, and commercially-insured. Uninsured residents and Medicaid recipients were able to access F&C free of charge while commercially-insured participants contributed a co-pay based on their health plan's coverage. Of the 1,334 participants in the study, 806 were on Medicaid, while 423 were uninsured and 105 had commercial insurance, as shown in the graph below.
Findings
At 12 months, the researchers were able to reach 648 participants for follow-up, and found that of those reached 30.6% were quit. For assessment purposes, being quit meant not using tobacco at the time of the assessment call and having been quit for a period of at least seven days.
When researchers looked at participants' adherence to F&C, they found that commercially-insured participants completed an average of 3.7 calls (of a possible 5); uninsured participants completed an average of 3.1 calls; and participants receiving Medicaid completed an average of 2.8 calls.
Furthermore, of the 648 participants contacted, those who completed five or more calls had a quit rate of 37.9% while those who only completed one call had a quit rate of 16.7%. In general, at 12 months, quit rates across all 3 groups were higher when more calls were completed.
Conclusion
The study showed that for adult smokers in Oregon, those with commercial insurance were more likely than those with Medicaid or no insurance to have completed the highest number of counseling calls with Free & Clear. There was a small relation between numbers of calls completed and higher quit rates; but the quit rate across all three study groups (for those contacted) was 30.6% at 12 months.
The difference in number of calls completed in relation to insurance status is an interesting finding that prompted the researchers to call for further investigation. More "real world" investigations need to be conducted in order to help researchers and policy makers better understand how factors like insurance status affect tobacco use and cessation.