An update on the effects of tobacco cessation services on smoking rates among Massachusetts Medicaid recipients

Background: Massachusetts implemented Medicaid tobacco cessation services in July, 2006. Prior research using data from the Massachusetts Behavioral Risk Factor Surveillance System (BRFSS) survey reported a 26% decline in smoking rates among working-age Medicaid members in the 30 months following the implementation, suggesting the new services were responsible, at least in part, for the decline. We extend prior research using additional BRFSS data and new methods. Methods: We use logistic regression and propensity score techniques to adjust the smoking rate estimates for changes in the composition of Medicaid participants over time, and a differences-in-differences method to account for changes in smoking rates that would have occurred in the absence of the Medicaid change. These methods account for the expansion of health insurance coverage in Massachusetts which occurred simultaneously with the implementation of the tobacco cessation services. Results: Using these techniques and a longer time period, we are not able to fully corroborate prior research, suggesting that the short-term decrease in smoking rates among the Massachusetts Medicaid population previously reported may not occur over the long term. Conclusions: The long-term effects of the tobacco cessation benefit may be dependent upon relapse rates and continued high utilization. Future research on these topics is required.