Helping Smokers Quit: Crossing Boundaries Across Medicaid, Public Health, and Other Sectors

Project Summary

The project team analyzed the relation of state tobacco use cessation efforts, other tobacco policies, and individual characteristics on the smoking and quitting behavior of Medicaid smokers.

Research Question(s)

  • To what extent do Medicaid policies (e.g., coverage of benefits, copayments, etc.), and implementation efforts (i.e., level of utilization of tobacco cessation medications) and other state policies (e.g., cigarette taxes) affect the extent to which Medicaid beneficiaries smoke or try to quit?


  • Inform policy-making by highlighting which policies have the most robust effects on smoking behaviors.


  • In analyses of the 2010 and 2015 National Health Interview Survey about smoking behaviors among low-income Medicaid beneficiaries, we find that state Medicaid expansions are associated with lower prevalence of smoking. (However, there were no significant relationships of Medicaid expansions for other, more specific cessation behaviors.)
  • Smokers were more likely to report trying to stop smoking when there were higher state rates of medication use. 
  • Prior research has suggested that combined cessation medication use and counseling are more effective in helping smokers quit. We found that when Medicaid programs do not cover cessation counseling, although they cover medications, the enrollees report less counseling.
  • This suggests that state Medicaid programs can strengthen efforts to help smokers quit through coverage of cessation counseling and by further promotion of medication utilization. Medicaid expansions can help increase access of tobacco cessation to more low-income smokers and reduce smoking rate.

Outcomes & Methodology

Pooled models using panel data methods (e.g., fixed effects, random effects or difference-in-difference) were created to examine:

  • The effect of state-level tobacco cessation utilization measures and other state policies on whether a Medicaid enrollee is a current smoker or not.
  • Whether Medicaid policies affect whether they tried to quit smoking in the past year or not.
  • Whether higher levels of state tobacco cessation utilization in one year are associated with more Medicaid enrollees reporting that they are former smokers in subsequent years.

no smoking sign formed out of thousands of tiny people
Grantee and Partner organizations

George Washington University Milken Institute School of Public Health 

Grant status
Principal investigators
Leighton Ku, PhD, MPH
Brian Bruen, PhD
Start date
Award amount
12 months

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