Prevention Matters

Partnership for Prevention’s second ActionToQuit state summit was held on September 28 in Buffalo, New York. The event brought together organizational representatives, leaders, and advocates committed to saving lives and improving health through tobacco cessation. The summit was led by the New York State (NYS) Smokers Quitline, which received a grant from Partnership for Prevention to develop a state plan for tobacco cessation.

David Zauche, Senior Program Officer at Partnership for Prevention, provided the keynote address at the Buffalo summit. He stressed that tobacco cessation offers the highest value of all preventive services, receiving the top rating by the National Commission for Prevention Priorities for health impact and cost effectiveness. He noted the Centers for Disease Control and Prevention’s recommendation that tobacco cessation services be covered benefits for all employees, and he explained how federal health reform will positively impact cessation in the nation.

Currently there are 2.7 million smokers in New York State. Leaders from the state quitline and other agencies and organizations set an ambitious goal of reducing that number by one million by the year 2014. This would entail reducing the adult smoking prevalence from 18% to 12%. Fortunately, most cessation indicators are moving in the right direction in New York.

• There have been steady increases in the past decade in the percentage of smokers receiving assistance from their health care provider
• Similar increases have been seen in the percentage of smokers making a quit attempt
• The NYS Smokers Quitline is heavily promoted, providing free telephone and online cessation services and free medications to thousands of people each year
• Paid media campaigns reinforce the need to quit and cessation centers exist to provide additional help

In a strongly worded letter to President Obama and Members of the US House and Senate, Partnership for Prevention joined key national and state public health leaders in supporting the Environmental Protection Agency’s (EPA) effort to reduce emissions that contribute to climate change. The September 28 correspondence advised US political leaders to “fully support the EPA in fulfilling its responsibilities” and oppose “any efforts to weaken, delay or block the EPA from protecting the public’s health from these risks.”

The letter acknowledges “the threat to public health posed by climate change” and urged support for “measures that will reduce these risks and strengthen the ability of our local, state and federal public health agencies to prepare for and respond to the impacts of climate change.”

In addition to Partnership for Prevention, national organizations signing the letter included American Academy of Pediatrics, American College of Preventive Medicine, American Lung Association, American Medical Association, APHA, ASTHO, NACCHO, NALBH, Trust for America’s Health and over 100 public health organizations representing 37 states.


E. Ripley Forbes
Director, Government Affairs

September 26, 2010 marked the 10th anniversary of World Heart Day. Organized by the World Heart Federation, including the American Heart Association and the American College of Cardiology, World Heart Day calls attention to the death and disability caused by heart disease and stroke. Most people now understand that cardiovascular disease is the world’s leading cause of death and most people can identify at least some of the contributing risk factors – high cholesterol, high blood pressure, tobacco use. While we can name the threats, we are slower to recognize and embrace the policies and actions to prevent heart disease and stroke. Controlling diabetes, stopping tobacco use, eating more nutritiously and being more physically active are all important ways to help your heart stay healthy.

This year’s World Heart Day focus was workplace wellness. Most working adults spend the majority of their day at work and what we do at work affects our heart health. One of Partnership’s signature programs, Leading by Example (LBE) promotes workplace health through CEO to CEO engagement. Our LBE publications highlight the efforts of leading companies to build and support a healthy workforce.

Make your heart a 365 day project. Incorporate healthier practices while at work and home. Those working virtually or at home aren’t off the hook. Take a walk, put down the candy bar or cigarette and think about other ways to protect your heart during your work day.

For more information on Leading by Example click here, and for worksite health click here.


Diane Canova
VP, Policy and Programs
Partnership for Prevention

The bill introduced in California to require schools to provide free drinking water in eating areas was named the “Best News for Prevention” while the new report showing the high price of obesity was named the “Worst News for Prevention.”

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Bill seeks to add free water to school menus

In many California school cafeterias, there's no free water to drink. Surprised?

"Everyone I talked to says, 'You're kidding,' " said state Sen. Mark Leno (D- San Francisco).

Leno has introduced legislation to change that. His bill requiring schools to offer drinking water at no charge to students has passed the Senate and Assembly and awaits the governor's signature — a fairly sure thing because the governor sponsored the bill.

"As we all know, young people are constantly bombarded by advertisements and pressure from their peers to consume junk beverages that are high in calories and sugar. Yet many students do not have access to free, fresh drinking water at lunchtime," Leno said in material promoting his bill.


WORST

Obesity hurts your wallet and your health


Obesity puts a drag on the wallet as well as health, especially for women.

Doctors have long known that medical bills are higher for the obese, but that's only a portion of the real-life costs.

George Washington University researchers added in things like employee sick days, lost productivity, even the need for extra gasoline — and found the annual cost of being obese is $4,879 for a woman and $2,646 for a man.

That's far more than the cost of being merely overweight — $524 for women and $432 for men, concluded the report being released last Tuesday, which analyzed previously published studies to come up with a total.


The “Best and Worst” awards are announced each week in “Prevention Matters,” the blog of Partnership for Prevention. "Best and Worst News for Prevention” is based on a purposive sample of expert staff members who each week choose to share their opinions on the best and worst news for prevention. More information is available at http://www.prevent.org/.

Partnership for Prevention’s first ActionToQuit state summit was held on September 21 in Richmond, Virginia. The event brought together some sixty organizational representatives, leaders, and advocates committed to saving lives and improving health through tobacco cessation.

Over one million Virginians are current smokers, and 60% of them attempted to quit in the past year. This decade the smoking rate in the state declined steadily, while the quit attempt rate increased. The tobacco control community has given first priority to tax increases and smoke free public places, and many successes have been realized. But policy and system changes to advance tobacco cessation have not kept pace. Because of this, many people who want to quit have not had access to treatments that have been proven to work.

This summit was an outstanding example of state leaders coming together to solve a problem, in this case a deadly problem. If advocates are serious about significantly decreasing the smoking rate and its corresponding mortality, then change must occur. That’s why discussions centered on: 

• expanding Medicaid coverage in Virginia for tobacco cessation
• working with hospitals and health centers to routinely identify and treat tobacco users 
• urging all employers and private health plans to offer coverage 
• securing additional funding for the Virginia telephone quitline  
• convincing thought leaders and elected officials that cessation treatments are high value, saving lives and money  

The defeat of the Johanns Amendment was named the “Best News for Prevention” while the report showing that Americans are not eating enough fruits and veggies was named the “Worst News for Prevention.”

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Senate Defeats Effort to Eliminate Prevention and Public Health Investment Fund

On a procedural vote of 46 to 52, the Senate today defeated an effort to eliminate the Prevention and Public Health investment fund; one of the signature initiatives Partnership and other prevention advocates worked to include in the recently passed health reform legislation.

“We are grateful the Senate has affirmed the value of investing in evidence-based programs to help individuals and families live healthier lives. The passage of health reform represented an important compact with the American people to transform our current sick care system into a health care system that places value on keeping people healthy,” said Robert J. Gould, President and CEO of Partnership for Prevention.

The Johanns (R-NE) Amendment was offered to HR 5297, the “Small Business Jobs and Credit Act.” The amendment proposed to offset the costs of eliminating a tax code reporting requirement by eliminating funding Congress reserved to support community-based programs to reduce chronic disease rates, address health disparities and strengthen the “evidence-base for effective prevention programming.” Had the amendment passed, over $10 billion in prevention funding would have been cut from vital public health and prevention programs.


WORST

Americans still skipping fruits, veggies


Most Americans still don't eat vegetables often enough, and fruit consumption is actually dropping a little, according to a new government report released Thursday.

The Centers for Disease Control and Prevention found that last year about one-third of U.S. adults consumed fruit or fruit juice at least twice a day. That's down slightly from more than 34 percent in 2000.

Only about 26 percent ate vegetables three or more times a day, the same as in 2000. The statistics come from a national telephone survey of hundreds of thousands of Americans..


The “Best and Worst” awards are announced each week in “Prevention Matters,” the blog of Partnership for Prevention. "Best and Worst News for Prevention” is based on a purposive sample of expert staff members who each week choose to share their opinions on the best and worst news for prevention. More information is available at http://www.prevent.org/.

The American Lung Association released the results of a nation-wide study Tuesday showing that investing in smoking cessation services saves lives and money. Researchers at Penn State University studied the costs and benefits of behavioral and pharmacologic programs to determine if the costs of making smoking cessation programs available on the state-level could be justified by the benefits. The study specifically took into account the costs that smoking cessation would have on each state, such as lost tax and retail revenue, as well as the benefits each program would have. Researchers focused on the state-level, since it is ultimately the state that is responsible for insurance regulation and coverage decisions.

Researchers conducted a cost-benefit analysis on smoking cessation treatments, which included nicotine replacement therapy (NRT), bupropion, and varenicline, both with or without smoking cessation counseling. Benefits included in the analysis were a reduction in direct and indirect medical expenses, as well as increased workplace productivity and a reduction in premature deaths. Costs included in the analysis were the direct costs of the smoking cessation programs, lost tax revenue and lost revenues to retailers and distributors.

Results from this study showed that the annual direct costs to the economy due to smoking were greater than $298 billion. Among these direct costs were workplace productivity losses of an estimated $67.5 billion, premature death losses of $117 billion, and medical expenditures of $116 billion. While a pack of cigarettes on average costs $5.51, taking into account these medical costs and productivity losses, a pack would cost approximately $18.05.

While the Centers for Disease Control and Prevention and the Department of Health and Human Services have issued recommendations on smoking cessation, access to these treatments is not guaranteed and many payers do not provide coverage for smoking cessation. The health benefits of smoking cessation have been known for some time, but there is now economic justification as well. Now it’s time to urge states to take action. If states offer coverage for smoking cessation they will realize health and financial benefits. Researchers have estimated that with every dollar states spend on smoking cessation, they will save on average $1.26. Partnership for Prevention urges all states to join Indiana, Massachusetts, Minnesota, Nevada, Oregon and Pennsylvania in expanding comprehensive coverage to Medicaid recipients to save lives and money.


Katie Burggraf
Tobacco Control Team
Partnership for Prevention

The new baby carrot campaign to get people excited about eating their vegetables was named the “Best News for Prevention” while the report showing that five million eligible children in the U.S. are not enrolled in Medicaid or CHIP was named the “Worst News for Prevention.”

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Oh snap! New baby carrot campaign mimics junk food

Baby carrot farmers are launching a campaign that pitches the little, orange, crunchy snacks as daring, fun and naughty — just like junk food.

A group of 50 producers hopes the 'Eat 'Em Like Junk Food' effort starting next week will double the $1 billion market in two or three years.

The goal is to get people to think of baby carrots as a brand they can get excited about — not just a plain, old vegetable. A website, www.babycarrots.com, features metal music and deep male voices chanting "Baby. Carrots. Extreme." On social networking site Twitter, the campaign's account suggests people eat them "like there's no tomorrow (maybe there won't be...)"

WORST

Medical programs missing millions of kids: report


An estimated five million uninsured children in the United States were eligible for Medicaid or the Children's Health Insurance Program (CHIP) but were not enrolled in either plan, according to a new report.

The study published last Friday in the journal "Health Affairs" recommended policy reforms and broader efforts to get uninsured children into government medical programs, including the use of income tax data for automatic enrollment.

An estimated 7.3 million children were uninsured on an average day in 2008 and 65 percent of them were eligible for Medicaid of CHIP coverage, the report said.


The “Best and Worst” awards are announced each week in “Prevention Matters,” the blog of Partnership for Prevention. "Best and Worst News for Prevention” is based on a purposive sample of expert staff members who each week choose to share their opinions on the best and worst news for prevention. More information is available at http://www.prevent.org/.

President Barack Obama issued a Proclamation from the White House earlier this month declaring September “National Childhood Obesity Awareness Month.” He said childhood obesity was a national crisis “with nearly one in every three of America's children being overweight or obese” and noted that obesity affects children in every state, that “particular racial and ethnic groups are more severely impacted” and that “obesity can be influenced by a number of environmental and behavioral factors, including unhealthy eating patterns and too little physical activity at home and at school.”

The President acknowledged that more must be done “to halt and reverse this epidemic, as obesity can lead to severe and chronic health problems during childhood, adolescence and adulthood, including heart disease, diabetes, cancer, and asthma.” Nearly $150 billion is spent annually on obesity-related medical conditions. “This is not the future” he added “to which we want to consign our children, and it is a burden our health care system cannot bear.

Partnership believes the Proclamation is a timely and important opportunity to remind Americans of the goals and accomplishments of the First Lady’s "Let's Move!" initiative to combat childhood obesity. “Let’s Move” is an historic public health campaign guided by the recommendations of a Task Force on Childhood Obesity which was charged with review of all programs and policies relating to child nutrition and physical activity and development of a national action plan to maximize federal resources and set concrete benchmarks that can end childhood obesity in a generation. The Task Force has produced a report containing a comprehensive set of recommendations and “strategies to address childhood obesity, including providing healthier food in schools, ensuring access to healthy affordable food, increasing opportunities for physical activity, empowering parents and caregivers with better information about making healthy choices, and giving children a healthy start in life.”

Reducing the incidence of childhood obesity will not be easy or quick. While this crisis has been building for three decades growing awareness and resolve across all sectors of our country provide hope that the President’s goal of reducing childhood obesity to 5% by the year 2030 is achievable.

“Our history shows that when we are united in our convictions, we can safeguard the health and safety of America's children for generations to come. When waves of American children were stricken with polio and disabled for life, we developed a nationwide immunization program that eradicated this crippling disease from our shores within a matter of decades. When we discovered that children were going to school hungry because their families could not afford nutritious meals, we created the National School Lunch Program. Today, this program feeds more than 30 million American children, often at little or no charge. When we work together, we can overcome any obstacle and protect our Nation's most precious resource -- our children. As we take steps to turn around the epidemic of childhood obesity, I am confident that we will solve this problem together, and that we will solve it in a generation.

Partnership for Prevention, the Congressional Prevention Caucus and the Preventive Cardiovascular Nurses Association are sponsoring two Capitol Hill briefings on September 21 to broaden the awareness of legislators and congressional staff about the threat childhood obesity poses to our nation. The briefings, “Eliminating Childhood Obesity: Developing National Consensus on a Prescription for Change” will include presentations by some of the nation’s most distinguished medical leaders including:

Ursula Bauer, PhD, Director, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention

Joe Thompson, MD, MPH, Surgeon General for the State of Arkansas and Director of the Robert Wood Johnson Foundation Center to Prevent Childhood Obesity

Laura Hayman, PhD, RN, Associate Dean for Research and Professor of Nursing in the College of Nursing and Health Sciences, University of Massachusetts, Boston

These briefings are open to the public. Anyone interested in attending can send their contact information and indicate whether they will attend the House or Senate briefing to meetings@prevent.org

This week’s Morbidity and Mortality Weekly Report (MMWR) was dedicated to new and disappointing findings in tobacco control. In addition to the article on secondhand smoke exposure, referenced in a Partnership blog posted yesterday, the Centers for Disease Control and Prevention also published, “Vital Signs: Current Cigarette Smoking Among Adults Aged ≥ 18 Years – United States, 2009.” Researchers at the CDC used data from the 2009 National Health Interview Survey and the 2009 Behavioral Risk Factor Surveillance System to determine adult smoking prevalence rates on both the national and state level.

Researchers found that in 2009, 20.6% of adults in the U.S. were current smokers. For the purposes of this study, cigarette smokers were defined as “adults aged ≥ 18 years who reported having smoked ≥ 100 cigarettes in their lifetime and now smoke every day or some days.” Among these smokers, 78.1% reported smoking every day and 21.9% reported smoking on some days. Results also showed that smoking prevalence varied greatly among different subgroups of the population. Men (23.5%) had a higher smoking prevalence than women (17.9%); non-Hispanic whites (22.1%) and non-Hispanic-blacks (21.3%) had a higher smoking prevalence than Hispanics (14.5%) and Asians (12.0%); and smoking prevalence was higher in the Midwest (23.1%) and South (21.8%) and lowest in the West (16.4%). In addition, there were great variations in smoking prevalence rates among individuals with different education levels. Overall smoking prevalence was found to generally decline with increasing education. Nearly half of all adults who obtained a General Education Development certificate were current smokers, while (49.1%) compared to 5.6 %of people with a graduate degree (5.6%). Researchers also found smoking prevalence to be higher among those living below the federal poverty line (31.1%) than among those at or above the poverty level (19.4%).

The 2009 smoking prevalence rate of 20.6% means that we will not be able to meet our Healthy People 2010 goal of reducing adult smoking prevalence to less than 12%. Results from this study also show that having any decline in smoking prevalence among adults is unlikely since data analyzed in this study show that declines have stalled during the past five years, with no significant difference between smoking prevalence rates in 2005 (20.9%) and 2009 (20.6%).

Partnership for Prevention believes this report provides significant evidence to support the notion that more efforts are needed to help reduce the prevalence of this leading cause of morbidity and mortality in the U.S. A closer look at various subgroups reveals that we have many disparities we need to focus our tobacco control efforts on, such as education and income level, in order to drive smoking prevalence down. Partnership for Prevention advocates for price increases, comprehensive smoke-free policies, and anti-tobacco media campaigns in addition to ensuring that all smokers have access to tobacco cessation treatment they need to quit.


Katie Burggraf
Tobacco Control Intern
Partnership for Prevention

A person’s decision to light up can have serious consequences for their health, but also for the health of those around them. Secondhand smoke is known to cause heart disease and lung cancer in nonsmoking adults but also to cause sudden infant death syndrome, acute respiratory infections, middle ear disease, exacerbated asthma, respiratory symptoms, and decreased lung function in children. Given these health hazards, how effective are our nation’s safeguards at preventing this secondhand exposure?

This week’s Morbidity and Mortality Weekly Report (MMWR), “Vital Signs: Nonsmokers’ Exposure to Secondhand Smoke – United States, 1999-2008,” provides the answer to this question by determining the proportion of the nonsmoking population who are exposed to secondhand smoke and by analyzing past trends in secondhand smoke exposure as determined by the 1999 to 2008 National Health and Nutrition Examination Surveys. Study results showed that the prevalence of secondhand smoke exposure among nonsmokers declined from 52.5% during the 1999-2000 survey to 40.1% during the 2007-2008 survey.

Despite this significant decrease in secondhand smoke exposure, this decline was only present for nonsmokers who did not live with a smoker in their home and also was not significant for non-Hispanic whites. This decline has also been shown to fluctuate from year to year and to be quite inconsistent. Furthermore, disparities among secondhand exposure still exists and study results have shown that exposure during every survey cycle is greater among men than among women; among non-Hispanic blacks than among non-Hispanic whites and Mexican-Americans; among children and youth than among adults; and among those below the federal poverty line than among those at or above the federal poverty line. What is most impressive, however, is that despite this decline in secondhand smoke exposure, 88 million nonsmokers who are above the age of three were still exposed to secondhand smoke during 2007-2008 and among these 88 million, 32 million were America’s children and youth (ages 3-19 years).

The results reported in this MMWR have major implications for public health practice and policies. Partnership for Prevention advocates for increases in state, local, and voluntary smoke-free policies in order to make this decline in secondhand exposure consistent and to eliminate existing disparities, especially among youth and children. Currently only twenty-four states and the District of Columbia have comprehensive smoke-free laws covering workplaces, restaurants, and bars. Complete state-wide bans are needed in order to reduce secondhand smoke exposure and protect the American public.

Homes were also shown to be a major source of secondhand smoke exposure, especially for children. Following the American Academy of Pediatrics and the U.S. Public Health Service’s recommendation, Partnership for Prevention supports efforts to increase clinician interventions for those parents who smoke. It is recommended that these parents not only get help in quitting smoking, but are also educated about the harms of secondhand smoke.

The Healthy People 2010 goal of reducing secondhand smoke exposure among the nonsmoking population to less than 56% has been accomplished. However, there are still a vast number of Americans who are exposed to the potential dangers of secondhand smoke. With more smoke-free policies and a greater emphasis on preventing at-home exposure, we can do a better job of safeguarding America’s nonsmokers.


Katie Burggraf
Tobacco Control Team
Partnership for Prevention

The new Medicare benefit that provides coverage for tobacco cessation counseling to all smokers was named the “Best News for Prevention” while the stalling of youth smoking rates in recent years was named the “Worst News for Prevention.”

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Expanding Coverage: Medicare Offers New Tobacco Cessation Counseling Benefit

On August 25th, the U.S. Department of Health and Human Services announced an expansion of Medicare coverage that is supported by many tobacco control advocates around the nation. This new expansion offers coverage of evidence-based tobacco cessation counseling, allowing many more smokers to get the treatment that they need.

Despite the fact that Medicare provides coverage for over 43 million beneficiaries, tobacco counseling was previously only offered to those individuals who were diagnosed with or showed symptoms of a tobacco-related disease. This new benefit provides coverage for tobacco cessation counseling to all smokers. As Secretary Kathleen Sebelius explains, “For too long, many tobacco users with Medicare coverage were denied access to evidence-based tobacco cessation counseling. Most Medicare beneficiaries want to quit their tobacco use. Now, older adults and other Medicare beneficiaries can get the help they need to successfully overcome tobacco dependence."

WORST

Youth Smoking Rates Now Stalled


Although teen smoking rates dropped in the past decade, they have stalled in recent years, which means increased tobacco prevention efforts are needed, a new U.S. government study shows.

Between 2000 and 2009, cigarette smoking rates declined from 28 percent to 17.2 percent among high school students, and from 11 percent to 5.2 percent among middle school students, said researchers from the Centers for Disease Control and Prevention.

However, they noted that the declines between 2006 and 2009 were not statistically significant -- from 19.8 percent to 17.2 percent among high school students and from 6.3 percent to 5.2 percent among middle school students.


The “Best and Worst” awards are announced each week in “Prevention Matters,” the blog of Partnership for Prevention. "Best and Worst News for Prevention” is based on a purposive sample of expert staff members who each week choose to share their opinions on the best and worst news for prevention. More information is available at http://www.prevent.org/.