Prevention Matters

Partnership for Prevention’s ActionToQuit summit for the New England area was held on October 19 in Framingham, Massachusetts. The event brought together organizational representatives, leaders, and advocates from six states to learn about and discuss tobacco cessation policy strategies. The summit was convened by the American Lung Association, which received a grant from Partnership for Prevention to develop an action plan for tobacco cessation in New England.

David Zauche, Senior Program Officer at Partnership for Prevention, presented on the ActionToQuit Program and addressed the impact of health reform on tobacco cessation policies. He emphasized the need to strengthen cessation coverage for Medicaid beneficiaries. As of 2010, federal health reform mandates that all pregnant women insured under Medicaid be eligible for cessation treatment at no cost to them. While this is a step forward, Partnership for Prevention advocates that this benefit be extended to all Medicaid subscribers, providing barrier free access to comprehensive treatments for all tobacco users.

The focus of this summit was the Massachusetts Medicaid benefit, which the other five New England states will attempt to replicate. Lois Keithly, Massachusetts Tobacco Cessation and Prevention Program, and Ayesha Cammaerts, formerly of MassHealth’s Office of Clinical Affairs, presented information on the outstanding Massachusetts initiative, which shed light on several previously unanswered questions:

• If a tobacco cessation benefit is offered and promoted heavily, will a large number Medicaid subscribers use it?
• If they use the benefit, will a large number quit smoking? 
• If this occurs, can there be positive short term benefits as well as long term?  

The results were remarkable. Over a thirty month period 75,000 Medicaid subscribers in Massachusetts used the tobacco cessation benefit, and 33,000 quit smoking. The smoking rate for this population dropped from 38% to 28%, representing a 26% decrease. Additionally, significant decreases were seen in hospitalization rates for heart disease.

"Best and Worst News for Prevention” is based on a purposive sample consisting of expert staff members who each week choose to share their opinions on the best and worst news for prevention.

BEST

Big VA Study Shows Surgery Checklist Saves Lives

Answering such basic questions from surgery checklists — and involving everyone as a team, even patients — saved lives in Veterans Affairs hospitals, according to one of the most rigorous studies of patient safety in the operating room.

Surgery deaths dropped 18 percent on average over three years in the 74 VA hospitals that used the strategy during the study. Surgery team members all created checklists and discussed them in briefings before, during and after surgery. That's a somewhat novel concept in a setting where the surgeon has traditionally called all the shots.


WORST

Americans Still Reaching for the Salt Shaker


Despite constant pleas by public health experts to hold the salt, the sodium intake of the U.S. population hasn't decreased over the past 46 years, according to a new review.

Most of us eat a lot more sodium than is recommended, says researcher Adam Bernstein, MD, ScD, a research fellow in the department of nutrition at Harvard School of Public Health in Boston.


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/.

A new study printed in Current Medical Research and Opinion found that aspirin use for primary prevention of cardiovascular disease (CVD) could produce overall savings of $79.6 million dollars over 10 years for a base population of 1 million patients, while use for secondary prevention shows a savings of $32.2 million. Aspirin use for primary prevention was also shown to save $29 million in out of pocket costs, which is an immediate benefit for patients.

The study measured cost savings associated with aspirin use for the prevention of CVD. Savings are seen if this preventive service was increased to reflect current guidelines with the greatest savings for primary prevention (i.e. in those patients without CVD, but at risk). Current clinical guidelines recommend aspirin use for the primary prevention of heart disease in men and stroke in women.

In addition to producing millions of dollars in savings, the study reported that aspirin use for primary prevention of CVD would prevent 1273 heart attacks, 2184 angina events, and 565 ischemic strokes in a base population of 1 million patients. Aspirin use for the primary prevention of CVD is not just financially valuable – it saves lives.

Partnership for Prevention supports aspirin use for the primary prevention of heart disease and stroke. Partnership convenes the Aspirin Task Force (ATF), a multidisciplinary group of experts committed to promoting aspirin use for the primary prevention of cardiovascular disease. The ATF supports the USPSTF recommendations, and encourages men and women to speak to their health care provider to decide if aspirin use is right for them.

In addition to the aspirin initiative, Partnership’s National Commission on Prevention Priorities (NCPP) has identified aspirin use for primary prevention as one of the highest value clinical preventive services. In fact, the NCPP reports that if 90% of those who were recommendation to use aspirin did use aspirin, 45,000 lives per year would be saved.

This study, along with Partnership’s initiatives, shows the importance of aspirin use for the primary prevention of heart disease and stroke. In particular, the study reinforces the value of utilizing preventive services to benefit our healthcare system and society as a whole.

This week – October 17-23 – has been designated as National Teen Driver Safety Week. And, we have a good reason to celebrate – today’s edition of the Morbidity and Mortality Weekly Report states that in 2009 there were approximately 500 fewer teen deaths in motor vehicle crashes. During 2004-2008, the percentage of drivers aged 16-17 years involved in fatal crashes decreased by 36%.

However, we can’t be too joyful. In 2009, about 3,000 teens died in motor vehicle crashes – still the leading cause of death for teens.

The numbers do illustrate the value of teen driver safety programs, graduated driver licensing and more involved parents. Evaluations of the graduated driver license programs show a 20-40 percent reduction in crash risk for the youngest drivers.

The watch word – keep it up! The programs and policies in place are working. Communities need to continue to proactively enforce minimum drinking age laws, blood alcohol levels, and safety belt laws. Ongoing evaluation of value of anti-texting laws needs to occur as well to assess impact of distracting driving on teen motor vehicle crashes.


Diane Canova
VP, Policy & Programs
Partnership for Prevention

Think about how often you use your mobile phone and how many “apps” you’ve downloaded. Folks promoting health and wellness believe this could be a good way to engage people and to encourage healthy living. But, what do mobile phone users think? Not too much, judging by a recent survey conducted by the Pew Internet and American Life Project. Only 9 percent of mobile phone users indicated that they use phone apps to help track or manage their health.

Despite low usage now, public health officials remain optimistic that mobile technology is a good way to reach young people, as well as African Americans and Latinos. Like pedometers, scales and journals, mobile apps can assist in tracking food intake, exercise or smoking cessation. They can also provide reminders for medication usage and doctor’s visits. As more mobile applications become available, it will be interesting to see how these tools can assist health decision-making.

http://www.npr.org/blogs/health/2010/10/20/130703545/for-many-of-us-health-apps-are-just-not-part-of-our-routine


Diane Canova
VP, Policy & Programs
Partnership for Prevention

Partnership for Prevention’s fourth ActionToQuit state summit was held on October 14 in Orlando, Florida. Led by the American Lung Association in Florida, the event brought together 65 organizational representatives, leaders, and advocates committed to saving lives and improving health through tobacco cessation at the one of the newest facilities in Orlando, the Sanford-Burnham Medical Research Center at Lake Nona. The Orlando event was unique in that about 190 participants from 27 remote locations across Florida tuned into the summit virtually and participated in workgroups of their own to begin to develop a strategic plan for the state to increase access to tobacco cessation treatments.

The summit continued to take advantage of technology and social media throughout the day, encouraging participants to “tweet” updates from the summit with their Smartphone and to send in questions for presenters by email and text messages. On-site participants were polled on a variety of issues after each presenter using electronic polling keypads which allowed for the results to be displayed for the audience in seconds. These additional features of the Florida summit were definitely value-added and made for increased dialogue and participation.

As noted in the presentation given by Dr. Thomas Brandon, Director of the Tobacco Research & Intervention Program at the H. Lee Moffitt Cancer Center and Research Institute in Tampa, 17.5 percent of adults in Florida are current cigarette smokers. While over a span of 10 years at least 2-3 people die from shark attacks, 10 die from alligator attacks, and 10,000 people are murdered, tobacco use will kill 300,000 individuals.

Jennifer Singleterry, Manger of Cessation Policy at the American Lung Association, pointed out that smoking not only costs Florida thousands of lives each year, but there are also significant economic costs incurred. Each year Florida suffers $4.4 billion in workplace productivity losses; $7.9 billion in costs of premature death; and $7.3 billion in direct healthcare expenditures. These outrages losses, coupled with the prevalence of morbidity and mortality due to tobacco use, continue to make the case for providing a comprehensive cessation benefit in the state of Florida. For every $1.00 spent on providing cessation treatments, Florida has the potential to see an average return of $1.24.

Diane Canova, Vice President of Policy & Programs at Partnership for Prevention provided the presentation on health reform and what it means for tobacco addiction treatment. She 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. She also noted the recent expansion of Medicare coverage for cessation counseling to all tobacco users and other key provisions in the Affordable Care Act. The take-away message was that implementation of expanded coverage is key and we must keep tobacco a prominent priority in community prevention to truly drive down the number of tobacco users.

After the morning presenters, summit participants were divided into workgroups to begin making recommendations for the following audiences to ensure that they receive or provide comprehensive tobacco cessation coverage in the state of Florida: 1) healthcare industry; 2) government employees; 3) Medicaid recipients; and 4) businesses. The larger group reconvened at the end of the day to report out on the recommendations and everyone was pleased by the thought and work that had been put into them in such a short amount of time.

The American Lung Association in Florida and its partners will take the next step in the development of the statewide plan by gathering all the information received at the summit and choosing the recommendations that will hopefully lead to all employees in the state having comprehensive coverage. We look forward to seeing Florida’s plan sometime in December and helping them to implement their plan in the upcoming year.


Brandi Robinson
Tobacco Control Program Associate