Current Research & Projects

This is a $10 Million grant from the U.S. Centers for Medicare and Medicaid Services to the State of Connecticut and will be conducted in collaboration with Yale University, the Hispanic Health Council and other State agencies. Funding comes from the Medicaid Incentives for Prevention of Chronic Diseases grant program. The overall goal of this project is to improve residents' health and lower taxpayer's costs by helping Medicaid patients to quit smoking.

The program aims to significantly reduce smoking rates among the 25-30 percent of Connecticut (CT) Medicaid beneficiaries who smoke. Pregnant women and mothers of newborns and persons with serious mental illness will be a special focus of this program. By delivering incentives within person centered medical homes, obstetrics practices, and local mental health authorities we will leverage important changes to health care delivery under the Affordable Care Act. CT will take a multi-prong approach to smoking cessation, leveraging new comprehensive Medicaid coverage for evidence-based smoking cessation products.

This approach will be comprehensive, evidence-based, widely available to smokers and easily accessible. By including financial incentives to smokers for achieving both process (i.e., attending counseling sessions) and objectively verifiable outcome goals (i.e., smoking cessation) we will increase the quit rate in CT. The program will take a continuous collaborative learning approach, phasing-in services to determine the effectiveness of various approaches, and modifying the program as more is learned over the course of the four year program.

The evaluation plan will be overseen by Yale University, and its co-principal investigators, Drs. Jody Sindelar and Susan Busch, along with Project Coordinator, Mr. Kurt Petschke, from Yale's School of Public Health. Dr. Sindelar will work with the State to help to monitor the incentives. The yearly evaluations will be used as feedback and to continue to design the interventions in response to the findings from the previous evaluations. Dr. Busch will work with the State to help to plan the incentives with respect to the design of the randomization and overall design so that we can assess impact. Yale will consult on complex research design issues in the planning period and also aid in complex issues during the evaluations.

The overall goal of this project is to prevent future tobacco-related morbidity, mortality and medical care expenses in all smokers, but especially low-income smokers by adoption of novel, effective prevention measures delivered in non-medical venues.

We aim to accomplish this by building the empirical basis and beginning to develop a more effective motivation to quit smoking based on a financial message to quit. Developing such a low-cost, population-based, intervention would expand the number of delivery settings. Such non-medical settings could include grocery stores, banks, check-cashing locations, tax preparation offices, etc., each of which may offer its own teachable moments related to costs of smoking. The financial motivation can be tailored to special populations, e.g., double your tax refund by quitting smoking or save money for your new baby.

New venues and use of an effective, low-cost intervention will aid in reducing the smoking rates of low-income smokers and will address disparities in smoking, health and income. Using online web-based experiments and surveys, we will test whether the financial incentive to quit smoking is more effective than the health incentive. We will optimize the financial message by testing the impact of both priming the recipients to think about their financial situation and by tailoring to their specific smoking pattern.

Based on the findings and our expertise in addiction treatment and behavioral economics, we will begin to develop a low-cost, intervention for low-income smokers. Effective, population-based approaches reduces the strain on the overburdened health care system, consistent with the emphasis on health care reform and providing prevention programs for low-income communities

A collaborative, predoctoral interdisciplinary training program that will produce scholars who will receive rigorous grounding in an academic discipline (health economics, policy analysis, or organizational theory) and who will acquire extensive training and research experience in addiction.

This training will build on the considerable strengths of current teaching, clinical, and research enterprises at Yale University and will link state-of-the-art methods with some of the nation’s leading clinical and research experts in addiction. The primary focus will be on illicit drugs, tobacco and HIV/AIDS as a critical comorbidity occurring with HIV/AIDS.