Until November 12, 2002

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Behavioral Therapy, Other Types Of Support May Be Needed
To Help Smokers Kick The Habit


WASHINGTON, DC–Expanding health insurance coverage to include nicotine patches, nicotine gum, and other medications for quitting smoking failed to increase rates of smoking cessation, according to a study published today in the journal Health Affairs.

The study indicates that insurance coverage for smoking-cessation drugs on its own is not enough to change smokers' habits, even though these drugs have proved effective in clinical trials. Other types of support, such as behavioral therapy, may be needed in conjunction with medication use to increase smoking-cessation rates, the study authors suggested.

"This study tells us that drug coverage is only part of the answer," said lead study author Raymond G. Boyle, a researcher with the HealthPartners Research Foundation in Minneapolis. "Simply providing insurance coverage is not sufficient to increase quit rates."

The study involved a collaboration between two of Minnesota's largest health plans, HealthPartners and Blue Cross Blue Shield of Minnesota. In 1998, both plans created a pharmacy benefit covering all effective pharmacological aids for smoking cessation. Although most insured employer groups received this benefit as part of their contract, self-insured groups could opt out.

The study results were based on questionnaire responses from more than 2,300 health plan members who identified themselves as smokers. The majority of respondents - 1,560 - had the new smoking-cessation pharmacy benefit. A baseline questionnaire was followed up a year later to track use of smoking-cessation medications, efforts to quit smoking, and successful quitting. Among the findings:

• The new benefit did not help smokers kick the habit: Smokers who had pharmacotherapy coverage were no more likely to quit than those without the benefit, regardless of their interest in quitting in the next month.

• Awareness of the new benefit increased the likelihood that smokers would use smoking-cessation drugs and attempt to quit. However, smokers who knew they had pharmacotherapy coverage were no more likely than those who were unaware of the benefit to successfully quit smoking.

• At one-year follow-up, 30 percent of smokers with the new benefit reported knowing about it, while 6 percent of those without the benefit thought that they had it.

• Smokers with the benefit were no more likely than those without the benefit to report use of smoking-cessation products.

Although some health plans require smokers to take part in behavioral therapy to receive smoking cessation medications, the two health plans in the study did not have this requirement. Other studies have shown that the use of behavioral therapy in conjunction with smoking-cessation medications enhances smokers' efforts to quit. In addition, the researchers said that they observed no change in physicians' cessation-support behavior after the benefit was created.

"We need to find out if increasing awareness of benefits or adding other types of cessation support will help increase quitting," Boyle said.

Boyle co-authored the study with Leif I. Solberg, of HealthPartners Research Foundation; Sanne Magnan, and Nina L. Alesci, of the Center for Tobacco Reduction and Health Improvement, Blue Cross Blue Shield of Minnesota; and Gestur Davidson, of the University of Minnesota School of Public Health.


Health Affairs, published by Project HOPE, is a bimonthly multidisciplinary journal devoted to publishing the leading edge in health policy thought and research. Copies of the November/December 2002 issue will be provided free to interested members of the press. Address inquiries to Jon Gardner at Health Affairs, 301-656-7401, ext. 230, or via email, press@healthaffairs.org. Selected articles from the November/December issue are available free on the journal's Web site, www.healthaffairs.org.

©2002 Project HOPE–The People-to-People Health Foundation, Inc.