Addressing SDoH to Reduce Smoking Rates and Improve Health Equity


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How HCOs are addressing SDoH to promote smoking cessation in vulnerable populations

Cigarette smoking is one of the most pronounced examples of health inequities today. According to the Centers for Disease Control and Prevention (CDC), low-income cigarette smokers are disproportionately impacted by cigarette smoking than smokers with higher incomes. Research shows that populations with low socioeconomic status have higher rates of lung cancer risk than those in the most affluent groups. The reality is that smoking is a significant contributor to more than 480,000 smoking-related deaths every year, or about one in five deaths. However, tobacco use is the single most preventable cause of disease, disability, and death in the United States.

There is hope. Change begins with understanding that the social determinants of health (SDoH), especially income and education levels, must be accounted for to promote positive changes in individual behavior such as smoking cessation. And evidence points to ways that healthcare organizations (HCOs), aided by key community partnerships, can close the gap in health equity by tackling these factors head-on. Through innovations in care delivery, HCOs significantly reduce the health and cost outcomes of completely avoidable diseases associated with smoking.

Addressing SDoH to reduce smoking rates

In one of the most notable examples of widespread smoking cessation among vulnerable populations, more adults with low incomes quit smoking in states that expanded Medicaid than adults in states that did not. According to the University of Pittsburgh Graduate School of Public Health, this improvement was due to a combination of factors. First, Medicaid expansion helped more adults on low incomes access primary care services, where primary care providers commonly screen for smoking and offer information about smoking cessation programs. And many of these programs are funded, in part, by Medicaid, as the Affordable Care Act made smoking cessation programs a mandated component of Medicaid expansion.

It’s likely that Medicaid will continue to be one of the primary forces behind the national smoking cessation effort, especially as enrollees are more than twice as likely to smoke compared to those who are privately insured. In one of the starkest examples of health disparities, smoking rates for Medicaid enrollees are 25.3 percent, while prices for the privately insured are 11.8 percent. As Medicaid continues to evolve into a value-based preventative care model, governors in states such as Ohio have indicated that smoking cessation will be part of an overall emphasis on wellness in the state’s managed Medicaid contracts.

Other programs are funded in part by settlements with tobacco companies, such as the Maryland Cigarette Restitution Fund, which has helped the Johns Hopkins Center to Reduce Cancer Disparities (JHCRCD) take an anti-smoking campaign directly to Baltimore neighborhoods. Through education sessions, nicotine replacement therapy and a four-week follow-up period of individualized phone counseling, the health system is helping residents from communities across Baltimore to quit smoking. Many of the participants in this program also have related chronic conditions, such as asthma or COPD—and quitting smoking has alleviated some of their worst symptoms. One participant noted that after quitting smoking, she no longer relied on an inhaler to help breathe.

Key SDoH takeaways

These and other programs speak to a larger healthcare trend across the country, including among commercial insurers. For HCOs that are determined to reduce health disparities in their communities, this trend points to a clear path forward to help populations that are the most affected by preventable chronic conditions and promote positive behavior change.

To learn more about closing the gap in health equity and addressing SDoH, check out our latest white paperSDoH Strategy, Programs, and Infrastructure: The 3 Keys to Building a Network of Community-Based Organizations. In this white paper, we examine best practices for cross-sector partnerships and the key components needed to build a network of community-based organizations (CBOs). 

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Topics: social determinants of health health disparities

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