Click on the sections below to learn more about the research and projects we are conducting.
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.
With passage of the 2009 Family Smoking Prevention and Tobacco Control Act, the FDA gained power to regulate tobacco products and created the Center for Tobacco Products. To regulate effectively, the FDA must develop a strong knowledge base especially in an era of modified risk tobacco products (MRTPs). MRTPs are tobacco products that claim to reduce tobacco-related harms. Some are emerging products such as e-cigarettes and genetically modified tobacco products. Others are established products such as menthol cigarettes. The FDA must evaluate whether tobacco products, as used by consumers, lower risk to the U.S. population. E-cigarettes, for example, may lower risk but also may entice youths to smoke cigarettes and prevent smokers from quitting. Individuals may incorrectly perceive that menthol lowers risk. To prevent public health harm, the FDA requires information on net impact of tobacco products and must consider young people who are at risk of starting to use tobacco products as well as current and former smokers.
To develop the critical knowledge to regulate, we use the lens of economics and conduct school-based and online experiments. Experiments can provide information on emerging combinations of attributes of products in advance of wide-spread use. We will combine findings from our experiments with secondary data sets to predict use of and perceptions about tobacco products in nationally representative populations. Using large samples, we analyze sub-population heterogeneity: differences by age, gender and race, SES and combinations, i.e. women of child-bearing age and young minority smokers.
The overarching aim is to develop the knowledge base useful for effective tobacco product regulation to reduce nicotine addiction. To meet this aim, we will examine factors that influence both the perceptions of risk and interest in using tobacco products, including MRTPs; factors include both attributes of tobacco products as well sources of information about risks. In aims 1 and 2 we examine attributes of products and in aims 3 and 4 we examine formal (e.g., government) and informal (e.g., peers) sources of information (e.g., FDA) about risks. In aims 1-4 we will conduct Discrete Choice Experiments (DCEs) to reveal risk perceptions and interest in use across different populations varying by age, race, smoking status and SES. In Aim 5 we will apply findings from our experiments to nationally representative populations and vulnerable sub-populations.