January 23, 2025
A new study suggests that healthcare providers should prioritize tobacco cessation treatment for prevention, not just treatment for people with tobacco-related chronic disease. Researchers at the UC Davis Center for Healthcare Policy and Research (CHPR) studied California’s 1.5 million smokers who are covered by California’s Medicaid program, called Medi-Cal, to understand tobacco treatment disparities.
The Medi-Cal-enrolled population has higher rates of tobacco use and chronic disease relative to the rest of the population. This makes Medi-Cal members a critical target for prevention efforts, which the researchers say can save lives and money.
“Tobacco cessation treatment for the Medi-Cal population needs to improve because it will not only save lives, but also relieve long-term pressure on the health care system and the costs of treating tobacco-related diseases,” said Elisa Tong, a professor at the UC Davis School of Medicine and founding director of CHPR’s CA Quits program.
The research team used the California Health Interview Survey to analyze tobacco cessation treatment for Medi-Cal smokers, both with and without chronic disease. They found surprising disparities in the way these two groups reported about health professional advice and assistance.
Half of Medi-Cal smokers do not have a chronic disease; however, just a third of those smokers were advised to quit. Meanwhile, Medi-Cal smokers with a chronic disease were nearly twice as likely to be advised to quit and one-and-a-half times more likely to receive assistance.
“Smokers are at significant risk of chronic disease. Our findings suggest that many smokers without a chronic disease are not getting the advice or assistance that can help them quit tobacco,” said Tong. “So, it is critical to focus more prevention efforts on this population—before they’re facing a chronic disease stemming from tobacco use.”
Tong said Medi-Cal can address the gap in preventative care by crafting outreach strategies to advise and treat all their members who use tobacco. Such strategies could be as simple as connecting them to tobacco cessation treatment resources like the free state quitline, Kick It California.
“Community-engaged, population-based tobacco treatment services are essential to helping smokers quit, preventing disease and mortality, and saving money,” said Tong, who also explained that it is economically smart for health plans to focus on prevention.
Medi-Cal managed care plans already cover tobacco cessation treatment, including 7 medications with nicotine replacement therapy. A previous study showed that offering modest incentives to Medi-Cal tobacco users to engage with Kick It California saved $2 for Medi-Cal for every dollar spent. CA Quits works with health systems and plans serving the Medi-Cal population to advance and implement tobacco cessation treatment strategies.
Authors of the new study published by AJPM Focus included first author Nan Wang, a doctoral graduate in Public Health Sciences and a former graduate student researcher at CHPR; Melanie Dove, an assistant adjunct professor of Public Health Sciences at UC Davis; and Cindy Valencia, director of CA Quits. The Tobacco-Related Disease Research Program and the California Tobacco Prevention Program, California Department of Public Health provided funding support.