UMMS Affiliation

Commonwealth Medicine, Center for Health Policy and Research; Department of Psychiatry; Department of Family Medicine and Community Health

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Document Type



Behavior and Behavior Mechanisms | Community Health and Preventive Medicine | Health Policy | Health Psychology | Health Services Administration | Health Services Research | Substance Abuse and Addiction


The smoking rate among non-elderly Medicaid enrollees is more than double the rate for those privately insured; smoking-related conditions account for 15% of Medicaid expenditures. Under state health reform, Massachusetts Medicaid (MassHealth) made tobacco cessation treatment available beginning in 2006. We used surveys conducted in 2008 and 2014 to examine changes in smoking abstinence rates among MassHealth members identified as smokers and to identify factors associated with being a former smoker. Members previously identified as smokers were surveyed by mail or phone; 2008 and 2014 samples included 3,116 and 2,971 members, respectively. Surveys collected demographic and health information, asked members whether they smoked cigarettes "every day, some days or not at all', and asked questions to assess smoking intensity among current smokers. The 2014 survey included an open ended-question asking members "what helped the most" in quitting or quit attempts. We observed a significant decrease in members reporting smoking "every/some days" of 15.5 percentage points (p < .0001) from 2008 to 2014, and a significant decrease in smokers reporting smoking "more than 10 cigarettes on days smoked" of 16.7 percentage points (p < .0001). Compared to smokers, former smokers more frequently reported health concerns, the influence of family members, and the use of e-cigarettes as helping the most in quitting. Expanded access to tobacco cessation treatment under the Affordable Care Act may have help to reduce the high smoking rates among Medicaid enrollees. Additionally, smokers' concerns about health and the influence of family and friends provide opportunities for targeted intervention and messaging about quitting.


Massachusetts, Medicaid, smoking rate, MassHealth, tobacco cessation treatment

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Copyright: © 2017 Henry et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

DOI of Published Version



PLoS One. 2017 Oct 12;12(10):e0186144. doi: 10.1371/journal.pone.0186144. eCollection 2017. Link to article on publisher's site

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PloS one

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Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.