Adults on Medicaid, uninsured twice as likely to smoke

CDC researchers suggest more access to tobacco cessation treatments would help many more smokers quit.

By Stephen Feller

ATLANTA, Nov. 12 (UPI) -- The smoking rate of adults without insurance or on Medicaid is more than twice as high as among those who have private health insurance, according to new research from the Centers for Disease Control and Prevention.

Efforts to cut smoking have been most effective among people with access to information and cessation treatments that include counseling and medications, although their availability varies for Medicaid patients because not all state programs cover them.


Overall, the number of Americans who smoke cigarettes declined by more than five million -- from 20.9 percent of adults to 16.8 percent -- between 2005 and 2014, according to the CDC's Morbidity and Mortality Weekly Report. The agency called the large drop "marked progress" toward a goal of 12 percent, which was set as part of the Healthy People 2020 initiative.


"These findings underscore the importance of ensuring that proven strategies to prevent and reduce tobacco use reach the entire population, particularly vulnerable groups," said Dr. Brian King, deputy director for research translation in the CDC Office on Smoking and Health, in a press release. "Comprehensive smoke-free laws, higher prices for tobacco products, high-impact mass media campaigns, and barrier-free access to quitting help are all important. They work to reduce the enormous health and financial burden of tobacco use and secondhand smoke exposure among Americans."

CDC researchers surveyed 36,697 adults over age 18 as part of the 2014 National Health Interview Survey, finding cigarette smoking dropped "significantly" from 17.8 percent of Americans in 2013 to 16.8 percent in 2014.

The survey showed that 27.9 percent of uninsured adults and 29.1 percent of adults using Medicaid smoke, while 12.9 percent of adults with private insurance and 12.5 percent of people on Medicare are current smokers.

Among individual groups, the researchers found more men than women smoke, 18.8 percent as compared to 14.8 percent, and 20 percent of adults between the ages of 20 and 44 smoke. The CDC also identified other subsets of people as having "high" rates of smoking: 27.9 percent of multiracial people, 29.2 percent of American Indian and Alaska Natives, 43 percent of people with General Education Development certificates, 26.3 percent of people below the poverty line, 20.7 percent of residents of the Midwest, 21.9 percent with a disability or limitation of some sort, and 23.9 percent of lesbian, gay, or bisexual people.


The researchers noted smoking rates may be imprecise because, in to addition employing self-reported, non-validated surveys, researchers did not include people in the military or who have been institutionalized and did not assess gender identity, either of which could show differences in actual smoking rates.

Cessation coverage is used most when smokers and healthcare providers know the treatments available, the CDC said, however variability between private insurers and state-to-state Medicaid programs has limited usage of some treatments. As the number of adults with health insurance has increased because of the Affordable Care Act, the researchers said access to tobacco cessation treatments is improving and the number of people who smoke is decreasing.

"Smoking kills half a million Americans each year and costs more than $300 billion," said Dr. Tom Frieden, director of the CDC. "This report shows real progress helping American smokers quit and that more progress is possible."

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