Prevention Matters

Key Partnership senior staff are on hand at the National Conference of State Legislatures (NCSL) annual legislative summit being held this year in Louisville, Kentucky, July 25-July 28.  Partnership’s Government Affairs team worked closely with the NCSL Health Committee to host a special tobacco cessation briefing for state legislators and their staff members from across the country.  The briefing focused on the impact the Massachusetts Medicaid program experienced when it offered and promoted a comprehensive tobacco cessation benefit.  Although data is still being analyzed, the preliminary results are very promising.

Richard T. Moore, Senate Chairman of the Massachusetts Joint Committee on Health Care Financing and incoming NCSL President told the audience that:

1. Within just one year, users of the smoking cessation benefit had dramatic reductions in hospitalizations for heart attacks, declines in emergency and clinic visits for asthma, and a significant decrease in acute birth complications.
2. In the first two and a half years of the benefit over 75,000 MassHealth members have tried to quit smoking.  This represents 40 percent of smokers on MassHealth, a level unprecedented in the nation.
3. Researchers from the Massachusetts Tobacco Cessation and Prevention Program found that up to 38 percent fewer MassHealth cessation benefit users were hospitalized for heart attacks in the first year after using the benefit and 17 percent fewer benefit users visited the emergency room for asthma symptoms in the first year after using the benefit.
4. Researchers also found that there were 17 percent fewer claims for adverse maternal birth complications since the benefit was implemented.

In addition, the briefing included an important presentation from the MassHealth Deputy Medical Director Roger L. Snow, MD, MPH.  Dr. Snow reviewed the history of the MassHealth benefit and credited Senator Moore for having the vision to recognize that the availability and utilization of a comprehensive benefit could save lives and help control spending in the Medicaid program.  At Senator Moore’s urging, the legislature directed MassHealth to expand upon the Mass Department of Public Health’s limited telephone consultation service and adopt a comprehensive cessation benefit.

Partnership for Prevention’s ActionToQuit initiative has developed a comprehensive state-by-state analysis of Medicaid coverage of tobacco cessation. Prepared in collaboration with the American Lung Association, Saving Lives and Money – Helping People on Medicaid Quit Tobacco offers clear guidance to states on necessary steps to provide a comprehensive cessation benefit in accordance with recommendations of the United States Public Health Service (USPHS).

In 2004, the U.S. Medicaid expenditures for tobacco related illnesses totaled $22 billion, which was 11% of the overall Medicaid expenditure. States like New Hampshire and Montana, with smoking prevalence rates among the Medicaid population at 80% and 70% respectively, both attributed 15% of Medicaid costs to smoking. Their combined smoking attributable costs to Medicaid were $173 million. Although both Arizona and Washington’s prevalence rates were lower than 70% in 2004, both states attributed 18% of Medicaid costs to smoking, totaling $841 million. Since a large portion of Medicaid’s funding goes toward treating tobacco related diseases, an up-front investment in prevention, including tobacco cessation, must be a consideration.

As mapped out in Saving Lives and Money, six states currently cover all the treatments Medicaid recipients need to quit tobacco – Minnesota, Indiana, Massachusetts, Nevada, Oregon and Pennsylvania. Twenty-one states provide most, but not all, recommended cessation treatments to all of their Medicaid recipients; eighteen states provide only a few cessation treatments or have uneven coverage; and four states fail to cover any of the recommended medications or counseling for Medicaid recipients who want to quit.

The 2010 Patient Protection and Affordable Care Act requires that all Medicaid programs cover a comprehensive cessation benefit for pregnant women on Medicaid beginning this fall. The Act also provides a one percentage point increase in the federal Medicaid matching rate to states that cover all preventive services given an ‘A’ or ‘B’ by the USPHS (including tobacco cessation) with no cost-sharing. These are important steps in the right direction but, as Saving Lives and Money points out, there is still much to be done.

The guide will be introduced next week at an important session of the National Conference of State Legislatures’ (NCSL) Health Committee meeting in Louisville, Kentucky. At Partnership’s urging, this year the NCSL Health Committee is hearing a presentation on the remarkable success of the Massachusetts Medicaid program in promoting a comprehensive tobacco cessation benefit and achieving unprecedented success in reducing tobacco prevalence among the Medicaid population and reducing tobacco related health care costs.

Please visit the ActionToQuit website, Resources section to download the guide: http://actiontoquit.org/resources/


Brandi Robinson
Program Associate
Partnership for Prevention

Robert J. Gould, PhD, President and CEO and Jason M.M. Spangler, MD, MPH, Senior Program Officer were interviewed this morning by Dr. Nieca Goldberg, a cardiologist and women's health expert at NYU Medical Center, on her radio show, "Doctor Radio", carried by Sirius XM Radio. The broadcast garnered interest from the public, as several people called/emailed in with specific screening questions.

In addition to fielding questions, Dr. Gould and Dr. Spangler discussed Partnership’s mission and stressed the importance of prevention. Dr. Gould and Dr. Spangler highlighted the critical work Partnership is accomplishing in the areas of tobacco cessation and control, vaccines, and aspirin use. Dr. Goldberg is a member of Partnership’s Aspirin Task Force, an advisory group tasked with increasing aspirin counseling and aspirin use for primary prevention of cardiovascular disease.

Dr. Gould and Dr. Spangler also touched on the new regulations that require insurance plans to provide United States Preventive Services Task Force (USPSTF) A and B recommended preventive services without cost sharing. These regulations will begin to remove barriers to access to preventive care.

The interview will be re-broadcast today at 5 pm Eastern, Friday July 16 at 5 am Eastern and Sunday July 18 at 5 am Eastern on Sirius channel 114 and XM channel 119.

If you don't have a Sirius or XM subscription, you can sign up for a 7-day free trial period by visiting this website: www.sirius.com/freetrial/register. We hope you will tune in.

In 2009, the Obama administration and Congress passed the Health Information Technology for Economic and Clinical Health Act (HITECH) to increase the use of Electronic Health Records (EHR’s). The law authorizes incentive payments through Medicare and Medicaid to clinicians and hospitals when they use EHR’s to achieve improvements in care delivery. On July 13, 2010 Secretary Sebelius announced the final rules to support meaningful use of EHR’s, officially launching a concentrated five-year national initiative to improve the health of Americans and reduce health care costs through their adoption and use.

Earlier this year Partnership for Prevention joined with its colleagues at Trust for America’s Health in submitting public comments on the HITECH rules, requesting that the clinical quality measures have a focus on preventive care, specifically those clinical preventive services that provide the highest value as recommended by the National Commission on Prevention Priorities (NCPP). These include influenza immunization rates, smoking cessation counseling, BMI screening and follow-up, cervical cancer and chlamydia screening, and aspirin therapy. We applauded the Department of Health and Human Services for including public health among its goals for implementation.

While the final rules do not include all the measures recommended, smoking status for patients 13 years old or older was included as a measured functionality. This is a victory for tobacco control advocates because recording smoking status may lead to an increase in the number of patients who receive smoking cessation treatment. The age threshold is important as counseling for adolescent smokers has been shown to be effective, approximately doubling long-term abstinence rates in the multiple studies. Additionally, this measure will be in accord with the 2008 Update to the Public Health Service Clinical Practice Guideline on Treating Tobacco Use and Dependence.

This is an exciting time in healthcare in America. Paper-based treatment, surveillance, and recordkeeping is yielding to same-time health communication. The 2009 law and the July 13 announcement of its rules will go a long way toward operationalizing these advances.

For more information:

http://www.hhs.gov/news/press/2010pres/07/20100713a.html

http://healthcarereform.nejm.org/?p=3732


David Zauche
Senior Program Officer
Partnership for Prevention

A new study by the Fred Hutchinson Cancer Research Center in Seattle showing that postmenopausal women who take fish oil supplements may reduce their breast cancer risk was named the “Best Prevention Idea of the Week,” while the recent news from the U.S. Food and Drug Administration that about 40 million doses of swine flu vaccine worth about $260 million will be destroyed because it's past the expiration date was named the “Worst Prevention Idea of the Week."

The “Best/Worst” awards are announced each week in “Prevention Matters,” the blog of Partnership for Prevention. Nominees are submitted by Partnership staff as well as the general public, and are voted on by the staff. Partnership for Prevention is a nonpartisan organization of business, nonprofit and government leaders who are working to make evidence-based disease prevention and health promotion a national priority. More information is available at http://www.prevent.org/.

BEST

Study Finds Fish Oil Supplements Linked to Lower Risk of Breast Cancer

Postmenopausal women who take fish oil supplements may reduce their breast cancer risk, a new study suggests.

The study focused on the potential health benefits of 15 different so-called "specialty" supplements to see if they affect breast cancer risk, said study senior author Emily White, an epidemiologist at the Fred Hutchinson Cancer Research Center in Seattle.

Fish oil supplements, made from fatty fish such as salmon, contain high levels of omega-3 fatty acids.

In the study, White and her colleagues asked more than 35,000 Washington state women who were between the ages of 50 and 76 and all past menopause to answer questions about their use of "non-vitamin, non-mineral supplements." All were participants in the Vitamins and Lifestyle (VITAL) cohort study, and none had a history of breast cancer.

After six years of follow up, 880 cases of breast cancer were identified.

WORST

40 Million Expired Swine Flu Vaccine Doses to Be Destroyed


About 40 million doses of swine flu vaccine worth about $260 million will be destroyed because it's past the expiration date, says the U.S. Food and Drug Administration.

The amount of the outdated vaccine, which will be incinerated, is more than twice the usual surplus and likely sets a record, according to the Associated Press.

One government estimate suggests that about 30 million more swine flu vaccine doses could expire and have to be destroyed. If that's the case, it means that more than 43 percent of the total supply of swine flu vaccine for the U.S. public will have gone to waste, the AP reported.

As Rob Gould, President and CEO of Partnership for Prevention, has stated, “the top priority for prevention spending should be tobacco control.” And what is the best way to focus our tobacco control efforts? The answer is youth. By focusing on youth we can prevent this addictive behavior before it starts.

The need to address youth smoking is pressing. CDC published a report in last week’s Morbidity and Mortality Weekly Report (MMWR) titled, “Cigarette Use Among High School Students–United States, 1991-2009,” which brings to light to the slowing progress in youth smoking prevention.

The CDC studied cigarette smoking trends among high school students in the United States by analyzing data from the 1991-2009 Youth Risk Behavior Surveys (YRBS), which are conducted every two years among high school students in grades ninth through twelve. When looking at three different variables: ever smoked cigarettes (whether a student had ever smoked, even just one puff), current cigarette use (whether a student had smoked at least one day in the past thirty days), and current frequent cigarette use (whether a student had smoked at least twenty days or more during the past thirty days), researchers found that high school smoking rates dropped rapidly in the late 1990s. However, the rate of decline substantially slowed down after 2003 and has continued to only decline very gradually since then. When analyzing data from different racial and gender groups for current cigarette use, rates also declined rapidly in the late 1990s and then either continued to decline gradually or leveled off after 2003 for all subgroups except for black female students, for whom current cigarette use continued to decline after 1999 without slowing.

These slowing rates have led to our failure to meet the Healthy People 2010 national health objective to reduce the prevalence of current cigarette use among high school students to 16% or less. It is noteworthy that the 2009 YRBS survey was administered before the federal tax increase for cigarettes and before the Family Smoking Prevention Act went into effect, both of which aim to reduce youth smoking. However, much work needs to be done if we are to address these slowing declines in current cigarette smoking trends among high school students in the United States.

Partnership for Prevention agrees with the CDC’s recommendations for “reductions in advertising, promotions, and commercial availability of tobacco products… combined with expanded counter-advertising mass media campaigns and… other well-documented and effective strategies (e.g., higher prices for tobacco products through increases in excise taxes, tobacco free environments, programs that promote changes in social norms, and comprehensive communitywide and school-based tobacco-use prevention policies).”

Additionally, in a recent column in Kaiser Health News, “The Prevention Dilemma,” Rob Gould states that tobacco control should be the top priority for health reform funding and youth prevention placed at the top of the list. He argues for a “nationwide public education campaign modeled on the highly successful Truth® campaign that dissuades thousands of young people from initiating tobacco use and encourages smoking cessation.”

The MMWR brings disappointing news in terms of tobacco control, yet hopefully can be the driving force to focus our public health and policies and resources on preventing youth smoking and make this a healthier nation.

Katie Burggraf
Partnership for Prevention Intern

A new study in the American Journal of Preventive Medicine showing that the construction of a light-rail system (LRT) resulted in increased physical activity and subsequent weight loss was named the “Best Prevention Idea of the Week,” while the recent report from Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) that 28 US states saw obesity rates increase last year was named the “Worst Prevention Idea of the Week."

The “Best/Worst” awards are announced each week in “Prevention Matters,” the blog of Partnership for Prevention. Nominees are submitted by Partnership staff as well as the general public, and are voted on by the staff. Partnership for Prevention is a nonpartisan organization of business, nonprofit and government leaders who are working to make evidence-based disease prevention and health promotion a national priority. More information is available at http://www.prevent.org/.

BEST

New Study Finds Public Transit Systems Contribute To Weight Loss and Improved Health

Increasing the availability of public transit systems is one among a number of modifications to the built environment that offers opportunities for increasing physical activity and reducing the prevalence of obesity and its associated problems. In a study published in the August issue of the American Journal of Preventive Medicine, researchers from the University of Pennsylvania, Drexel University and the RAND Corporation found that construction of a light-rail system (LRT) resulted in increased physical activity (walking) and subsequent weight loss by people served by the LRT. These findings suggest that improving neighborhood environments and increasing the public's use of LRT systems could improve health outcomes and potentially impact millions of individuals.

WORST

Adult Obesity Rates Rose in 28 States and Fell in Just One


28 US states saw obesity rates still rising last year, while the only place to experience a decline was the District of Columbia (D.C.), F as in Fat: How Obesity Threatens America's Future 2010, according to a report from the Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF). In 38 US states more than 25% of the adult population is obese. 19 years ago the number of US states with an obesity rate of over 20% was zero.

The USA has had the highest adult obesity rate in the world for several years.

1. Require health plans to cover all three types of counseling deemed effective by the PHS Guideline for tobacco cessation: individual (face-to-face), group and proactive telephone counseling.
2. Require health plans to cover all seven medications FDA-approved to treat tobacco addiction.
3. Comprehensive tobacco cessation treatments should be promoted to encourage tobacco users to quit.