UC Davis

INTRODUCTION: People who are covered by Medicaid have a higher smoking prevalence than the general population and are at an increased risk for tobacco-related disease, a major driver of Medicaid costs. California has the largest Medicaid program, called Medi-Cal, whose members also have higher tobacco-use rates and tobacco-related disease. Quitting is beneficial at any age, and health professional advice and assistance are a key indicator of smoking cessation. As Medi-Cal transforms to improve population health and health equity, this study aimed to understand both the prevention and treatment of tobacco-related disease by comparing health professional advice and assistance among all Medi-Cal members with and without chronic disease who smoke. METHODS: Using data from the California Health Interview Survey (2014, 2016-2018), the authors examined 3,517 Medi-Cal current smokers (age ≥18 years) who consulted a health professional and reported about having a chronic disease. The outcomes included receiving advice or assistance from a health professional to quit smoking. Adjusted logistic regression models were conducted to examine the association between chronic disease and the outcomes, including adjusting for frequency of office visits. RESULTS: Among 1,227,154 Medi-Cal members who smoke, over half (51.9%) of whom had at least 1 chronic disease, approximately half received cessation advice, and less than one third received smoking cessation assistance. Smokers with chronic disease were more likely to receive health professional advice (63.9% vs 33.7%, p<0.001) and assistance (37.7% vs 20.5%, p<0.001) than those without chronic disease. In adjusted models, smokers with chronic disease were almost twice as likely to receive advice (OR=1.97, 95% CI=1.39, 2.78) and 1.5 times as likely to receive assistance (OR=1.50, 95% CI=0.94, 2.38) as those without chronic disease, but the latter was not statistically significant. CONCLUSIONS: Medi-Cal members who smoke have tobacco treatment disparities between those with or without chronic disease, even after adjusting for the number of office visits. Medi-Cal population health strategies for tobacco cessation treatment will need to improve prevention, not just treatment, of tobacco-related disease to reduce the long-term burden on the healthcare system and associated costs.