Medicaid enrollees have a cigarette smoking prevalence (30.4%) twice as high as that of privately insured Americans (14.7%), placing them at increased risk for smoking-related disease and death. Individual, group, and telephone counseling and seven Food and Drug Administration (FDA)-approved medications are evidence-based, effective treatments for helping tobacco users quit. A Healthy People 2020 objective (TU-8) calls for all state Medicaid programs to adopt comprehensive coverage of these treatments. However, a previous MMWR report indicated that, although state Medicaid coverage of cessation treatments had improved during 2008-2014, this coverage was still limited in most states. To monitor the most recent trends in state Medicaid cessation coverage, the American Lung Association collected data on coverage of, and barriers to, accessing all evidence-based cessation treatments except telephone counseling in state Medicaid programs (for a total of nine treatments) during January 31, 2014-June 30, 2015. As of June 30, 2015, all 50 states covered certain cessation treatments for at least some Medicaid enrollees. During 2014-2015, increases were observed in the number of states covering individual counseling, group counseling, and all seven FDA-approved cessation medications for all Medicaid enrollees; however, only nine states covered all nine treatments for all enrollees. Common barriers to accessing covered treatments included prior authorization requirements, limits on duration, annual limits on quit attempts, and required copayments. Previous research in both Medicaid and other populations indicates that state Medicaid programs could reduce smoking prevalence, smoking-related morbidity, and smoking-related health care costs among Medicaid enrollees by covering all evidence-based cessation treatments, removing all barriers to accessing these treatments, promoting coverage to Medicaid enrollees and health care providers, and monitoring use of covered treatments.

Cardiovascular diseases, including heart disease, hypertension and heart failure, along with stroke, continue to be leading causes of death in the United States.1,2 Hypertension currently affects nearly 78 million* adults in the United States and is also a major modifiable risk factor for other cardiovascular diseases and stroke.1 According to data from the National Health and Nutrition Evaluation Survey (NHANES) in 2007–2010, 81.5% of those with hypertension are aware they have it, and 74.9% are being treated but only 52.5% are under control, with significant variation across different patient subgroups.1,3–6 Of those with uncontrolled hypertension, 89.4% reported having a usual source of health care, and 85.2% reported having health insurance.7 This is the current status, despite the fact that therapies to lower blood pressure and associated risks of cardiovascular events and death have been available for decades and various education and quality improvement efforts have been targeted at patients and healthcare providers. | The direct and indirect costs of hypertension are enormous, considering the number of patients and their families impacted as well as the healthcare dollars spent on treatment and blood pressure-related complications.8 Currently, hypertension affects 46% of patients with known cardiovascular disease, 72% of those who have suffered a stroke, and was listed as a primary or contributing cause in approximately 15% of the 2.4 million deaths in 2009.1 In 2008, the total estimated direct and indirect cost of hypertension was estimated at $69.9 billion.8 Thus, it is imperative to identify, disseminate and implement more effective approaches to achieve optimal control of this condition.

BACKGROUND: Diarrhea is a leading cause of childhood morbidity and mortality in sub-Saharan Africa. Data on risk factors for mortality are limited. We conducted hospital-based surveillance to characterize the etiology of diarrhea and identify risk factors for death among children hospitalized with diarrhea in rural western Kenya. METHODS AND FINDINGS: We enrolled all children <5 years old, hospitalized with diarrhea (≥3 loose stools in 24 hours) at two district hospitals in Nyanza Province, western Kenya. Clinical and demographic information was collected. Stool specimens were tested for bacterial and viral pathogens. Bivariate and multivariable logistic regression analyses were carried out to identify risk factors for death. From May 23, 2005 to May 22, 2007, 1,146 children <5 years old were enrolled; 107 (9%) children died during hospitalization. Nontyphoidal Salmonella were identified in 10% (118), Campylobacter in 5% (57), and Shigella in 4% (42) of 1,137 stool samples; rotavirus was detected in 19% (196) of 1,021 stool samples. Among stools from children who died, nontyphoidal Salmonella were detected in 22%, Shigella in 11%, rotavirus in 9%, Campylobacter in 5%, and S. Typhi in <1%. In multivariable analysis, infants who died were more likely to have nontyphoidal Salmonella (adjusted odds ratio [aOR] = 6.8; 95% CI 3.1-14.9), and children <5 years to have Shigella (aOR = 5.5; 95% CI 2.2-14.0) identified than children who survived. Children who died were less likely to be infected with rotavirus (OR = 0.4; 95% CI 0.2-0.8). Further risk factors for death included being malnourished (aOR = 4.2; 95% CI 2.1-8.7); having oral thrush on physical exam (aOR = 2.3; 95% CI 1.4-3.8); having previously sought care at a hospital for the illness (aOR = 2.2; 95% CI 1.2-3.8); and being dehydrated as diagnosed at discharge/death (aOR = 2.5; 95% CI 1.5-4.1). A clinical diagnosis of malaria, and malaria parasites seen on blood smear, were not associated with increased risk of death. This study only captured in-hospital childhood deaths, and likely missed a substantial number of additional deaths that occurred at home. CONCLUSION: Nontyphoidal Salmonella and Shigella are associated with mortality among rural Kenyan children with diarrhea who access a hospital. Improved prevention and treatment of diarrheal disease is necessary. Enhanced surveillance and simplified laboratory diagnostics in Africa may assist clinicians in appropriately treating potentially fatal diarrheal illness. Please see later in the article for the Editors' Summary.