The Receipt and Utilization of Effective Clinical Smoking Cessation Services in Subgroups of the Insured and Uninsured Populations in the USA

Subgroups among the uninsured and even the insured may be at increased risk for not receiving and utilizing effective clinical smoking cessation services. Data for this study came from 18 to 64 year old smokers in the 2005 National Health Interview Survey. Long-term uninsured (greater than or equal to one year) smokers were less likely to receive physician advice to quit than those continuously-insured in the past year. Being long-term and short-term uninsured (less than one year) was negatively associated with dependence treatments' use in quit attempts compared to the continuously-insured, even though the prevalence of quit attempts were similar between these groups. Intermittent-uninsurance (spell of uninsurance in past year) did not influence cessation services delivery or use. Even though Medicaid-insured smokers were more likely to be advised to quit than those privately-insured, they were less likely to use dependence treatments, especially if they had a spell of uninsurance in the past year. Provisions in the Affordable Care Act of 2009 that ensure coverage of effective cessation services for previously-uninsured individuals and Medicaid-insured smokers may increase access and potentially improve population cessation rates.