Coverage of tobacco dependence treatments for pregnant women and for children and their parents.

In 2000, 36% of the 32 million Medicaid recipients and 25% of pregnant Medicaid recipients were smokers. Rates of tobacco use in the general population were considerably lower: 23% of the general population in 2000 and 12% of pregnant women in 1999. Helping pregnant women to quit smoking would have enormous health benefits, including reducing tobaccorelated spontaneous abortions, rates of lowbirthweight infants, admissions to neonatal intensive care units, infant deaths from perinatal disorders, and sudden infant death syndrome. In addition, 9.2% of youths in grades 6 through 8 and 28.5% of youths in grades 9 through 12 reported being current smokers in 2000. Reduction in tobacco use by youths and their parents would also have important health benefits. Not only are children and adolescents harmed by exposure to secondhand smoke, but they also underestimate the addictiveness of nicotine and its future health consequences; 73% of teen daily smokers who think they won’t be smoking in 5 years are still smoking 5 to 6 years later. Nearly 90% of adult smokers had their first cigarette before they were 18 years old. The 2000 Public Health Service (PHS) clinical practice guideline Treating Tobacco Use and Dependence recommends health insurance payment for services demonstrated to be effective in helping smokers to quit, thereby reducing the barrier of cost. Nonmedication counseling interventions, including individual face-to-face, group, and telephone counseling, are recommended as the first line of treatment for pregnant smokers at the initial prenatal visit and throughout pregnancy, given the uncertain risks and benefits of pharmacotherapy for maternal and fetal health outcomes. For adolescents, the PHS guideline recommends assessing tobacco use and offering cessation counseling that increases quit rates above naturally occurring levels. The guideline also recommends that pediatricians “offer smoking cessation advice and interventions to parents to limit children’s exposure to secondhand smoke.” Medicaid requires states to cover specific preventive services, including prenatal care and Early and Periodic Screening, Detection, and Treatment (EPSDT) services for youths younger than 21 years. Coverage for additional preventive services, such as treatments for tobacco use and dependence, is optional and decided by each state. The purpose of this research was to determine the extent to which guidline-based tobacco dependence treatments are covered by state Medicaid programs for pregnant women, and under EPSDT for children and their parents who smoke.