title: Expansion of Medicaid covered smoking cessation services: maternal smoking and birth outcomes.
abstract: OBJECTIVE
  To assess whether Medicaid coverage of smoking cessation services reduces maternal smoking and improves birth outcomes.
  
  
  METHODS
  Pooled, cross-sectional data for 178,937 women with live births from 1996 to 2008, who were insured by Medicaid in 34 states plus New York City, were used to analyze self-reported smoking before pregnancy (3 months), smoking during the last 3 months of pregnancy, smoking after delivery (3-4 months), infant birth weight, and gestational age at delivery. Maternal socio-demographic and behavior variables from survey data and birth outcomes from vital records were merged with annual state data on Medicaid coverage for nicotine replacement therapies (NRT), medications and cessation counseling. Probit and OLS regression models were used to test for effects of states' Medicaid cessation coverage on mother's smoking and infant outcomes relative to mothers in states without coverage.
  
  
  RESULTS
  Medicaid coverage of NRT and medications is associated with 1.6 percentage point reduction (p<.05) in smoking before pregnancy among Medicaid insured women relative to no coverage. Adding counseling coverage to NRT and medication coverage is associated with a 2.5 percentage point reduction in smoking before pregnancy (p<.10). Medicaid cessation coverage during pregnancy was associated with a small increase (<1 day) in infant gestation (p<.05).
  
  
  CONCLUSIONS
  In this sample, Medicaid coverage of smoking cessation only affected women enrolled prior to pregnancy. Expansions of Medicaid eligibility to include more women prior to pregnancy in participating states, and mandated coverage of some cessation services without co-pays under the Affordable Care Act (ACA) should reduce the number of women smoking before pregnancy.
authors.affiliation: Emory University.
authors.forename: E Kathleen
authors.initials: EK
authors.lastname: Adams
authors.affiliation: Emory University.
authors.forename: Sara
authors.initials: S
authors.lastname: Markowitz
authors.affiliation: Centers for Disease Control and Prevention.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Dietz
authors.affiliation: Centers for Disease Control and Prevention.
authors.forename: Van T
authors.initials: VT
authors.lastname: Tong
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D008484:Medicaid / Q000458:organization & administration* / Q000706:statistics & numerical data; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000517:prevention & control; D011256:Pregnancy Outcome / Q000453:epidemiology; D012907:Smoking / Q000453:epidemiology*; D016540:Smoking Cessation / Q000706:statistics & numerical data; D000074606:Smoking Prevention; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Maternal and Perinatal Care and Outcomes; Medicaid; Observational Data / Quasi-Experiments; Substance Abuse: Alcohol / Chemical Dependency / Tobacco
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