Affordable Care Act linked to reduction in smoking among American adults with mental health and substance abuse disorders

In the first decade following the passage of the Affordable Care Act (passed in March 2010), American adults with mental disorders and addictions (MH/SUD) experienced significant increases in health care coverage. Health Insurance. They also showed significant reductions in smoking and increases in recent smoking abstinence. A new study published by the journal Addiction found that these two changes – increased health insurance coverage and better smoking outcomes – appear to be related.

This study, by a team including researchers from Harvard Medical School/Cambridge Health Alliance, compared trends in smoking and insurance coverage among nearly 450,000 American adults with and without HD/SUD, using the National Drug Use and Health Survey 2008-19 data. , an annual cross-sectional survey.

Study results are among the first to identify significant population-level reductions in smoking and increases in abstinence among adults with HD/SUD, a group that maintained significantly higher smoking rates over the past few decades despite public health measures and interventions that have driven change in the general adult population. A substantial proportion of the estimated improvements in smoking and abstinence outcomes for people with HD/SUD can be explained by increases in health insurance coverage.

Changes in smoking

From 2008 to 2019, American adults with HD/SUD reduced their smoking and increased their abstinence rates more than those without HD/SUD.

Specifically, current smoking rates of adults with HD/SUD decreased from 37.9% to 27.9%, while current smoking rates of adults without HD/SUD decreased from 21.4% to 16 .3%, a significant difference of a decrease of 4.9%. Daily smoking followed a similar trend, with a difference in decrease of 3.9%. Recent smoking abstinence rates among adults with HD/SUD fell from 7.4% to 10.9%, while recent smoking abstinence rates among adults without HD/SUD fell from 9.6 % to 12.0%, a difference in increase of 1.0%.

Changes in availability of health insurance

People with HD/SUD have historically had more limited access to care. Health insurance coverage for people with HD/SUD increased after 2014, when ACA provisions expanded the potential pool of individuals able to afford insurance coverage and improved treatment options based on evidence for insured persons.

In 2008-09, the prevalence of insurance coverage was 6.2 percentage points lower for adults with HD/SUD (71.9%) than for adults without HD/SUD (78.2%). By 2018-19, that difference had fallen to 2.0 percentage points.

The link between changes in smoking and changes in the availability of health insurance

This study found that in 2018-2019, 11% of net reductions in current smoking, 12% of net reductions in daily smoking, and 12% of net increases in recent smoking abstinence coincided with larger gains in smoking coverage. insurance for adults with HD/SUD. compared to adults without HD/SUD.

The study excluded adults aged 65 or older who were most likely to be covered by Medicare (public health insurance covering the elderly), and therefore less subject to most ACA provisions.

Provided by the Society for the Study of Addiction