Prevention Matters

The Associated Press (“Obama has kicked smoking habit, first lady says”) reported earlier this week that President Obama had “given up smoking.” The source for the report wasn’t the White House Press office but First Lady Michelle Obama. Mrs. Obama confirmed that the President had successfully quit smoking and had been smokefree “almost a year.”

This is wonderful news for the Obama family and for millions of Americans who struggle to quit smoking and wonder if they will ever be successful.

The President’s success sends an unmistakable message of hope to those struggling to quit. Now children whose parents smoke can refer to the President’s example and his struggle. Quitting is possible…even if you are President of the United States.

In a recent meeting of Partnership’s ActionToQuit state grantees, the news from Mrs. Obama was greeted with much excitement and admiration. In a letter of congratulations to the President these state tobacco cessation leaders wrote: “Your experience in quitting smoking gives hope to millions who struggle with their (tobacco) addiction. Your example – that quitting … is possible with the right combination of therapy and family support will encourage others to make the effort and realize the success, even in one of the world’s most stressful jobs.”

The ActionToQuit members joined Partnership VP Diane Canova in urging the President to take pride in his accomplishment and “consider sharing your experience to help other smokers seek out the smoke-free pathway to a longer, healthier life.”

The President’s experience with quitting tobacco is all too human. Quitting takes time. His example demonstrates perseverance and should encourage all of us to redoubling our efforts to expand access to tobacco cessation and encourage the types of social and family supports that increase smoking cessation success. The Affordable Care Act expands access to tobacco cessation through health insurance plans including Medicare and Medicaid. The new Prevention and Public Health Fund will make financial assistance available to help communities promote health and wellness including preventing and reducing tobacco use. These are important tools that can accelerate progress towards a healthier, smokefree nation.

But let’s not underestimate the important motivational role that examples of successful quitters can play. We hope the President’s struggle and his success will motivate others to successfully quit.

Partnership for Prevention has awarded three new ActionToQuit State Grants to Georgia, Iowa and Michigan for the implementation of innovative strategies to increase access to tobacco cessation treatments. Funds are to be used primarily for the development of state alliances/summit meetings and the creation of strategic plans. The projects will range from focusing on employer groups and health care systems to increasing cessation coverage for Medicaid recipients.

The six original ActionToQuit grantees - Colorado, Florida, Nevada, New England, New York and Virginia – have also received funds to continue efforts made in 2010. Funds will be used to the implement the state strategic plans developed during the first year of the program.

With funding from the Pfizer Foundation, Partnership hopes to dramatically increase access to and use of proven tobacco cessation treatments through this grant program. The focus of the ActionToQuit State Grants is system and policy change in tobacco cessation which will be accomplished through the strengthening of state level alliances for tobacco cessation. These alliances will chart a course for increasing coverage for these services in States, strengthen quitlines, work with health systems/employers/insurers, and promote the importance of tobacco cessation. As a result, utilization of these treatments will increase and tobacco use will decline.

To learn more about the ActionToQuit state grant program and the 2011 projects, please visit http://actiontoquit.org/stateprojects/.

Partnership for Prevention is pleased to announce 2011 funds for the current ActionToQuit state grantees. Colorado, Florida, Nevada, New England, New York and Virginia will receive $15,000 for the continuation of efforts made in 2010 to increase access to tobacco cessation treatments through policy and system change. Funds are to be used primarily for the implementation of the state strategic plans developed during the first year of the program.

Next month, Partnership will also award a second round of ActionToQuit grants to three new states. With generous funding from Pfizer Inc. and the Pfizer Foundation, Partnership for Prevention is working to dramatically increase access to and use of proven tobacco cessation treatments through this grant program. This will be accomplished through strengthening of state level alliances for tobacco cessation. These alliances will chart a course for increasing coverage for these services in States, strengthen quitlines, work with health systems/employers/insurers, and promote the importance of tobacco cessation. As a result, utilization of these treatments will increase and tobacco use will decline.

To learn more about the ActionToQuit state grant program and the 2010 projects, please visit http://actiontoquit.org/stateprojects/.


Brandi Robinson
Tobacco Control Program Associate

The Nevada ActionToQuit state summit was held in Reno on October 21, 2010. Led by the American Lung Association in Nevada, the summit brought together a diverse group of stakeholders to develop a state plan to reduce tobacco prevalence in Nevada by improving access to cessation treatments.

The summit opened with the State Health Officer as the keynote speaker to set the tone for the event. As noted by the keynote and other presenters, Nevada has a smoking prevalence rate of 21.5%. And of those smokers surveyed, 75% of them wish to quit. For every dollar Nevada spends on providing tobacco cessation treatments, it has an average potential return on investment of $1.31.

Panelists at the summit were all asked the following questions to help facilitate the formation of priority topics and inform the group strategic planning: 1) Please describe how your company or organization provides tobacco cessation services; 2) What impact has tobacco cessation had on your company, organization, or community?; 3) What are the barriers to people accessing tobacco cessation services?; 4) What other actions need to be taken to increase cessation in Nevada?; and 5) What do you think should be our priorities as we develop a statewide cessation plan for Nevada?

Following the presentations, participants at the summit prioritized areas and voted for the following workgroup topics: youth access, closing gaps in access, economic impact, educating officials, and expanding awareness of cessation. The 66 attendees choose which workgroup they wanted to participate in for the remainder of the afternoon and began to develop recommendations for the statewide plan, which will be available early in the new year.

The Nevada summit was a great first step to engage stakeholders in leading the way in increasing access to tobacco cessation treatment and ultimately decreasing tobacco use across the state.

In October, Partnership for Prevention sponsored Colorado’s ActionToQuit tobacco cessation summit in Denver. The event brought together organization, agencies, advocates, and leaders to discuss tobacco cessation policy strategies. The state-level summit was convened by the Colorado Tobacco Education and Prevention Alliance, which received a grant from Partnership for Prevention to develop a state action plan for tobacco cessation.

Colorado’s target audience is the 700,000 uninsured persons in the state, whose collective smoking rate is 32%, compared to 18% in the general population. At the summit, this new alliance of organizations learned about current tobacco cessation coverage gaps and shortly will create a comprehensive strategic plan for the state’s uninsured. Colorado has made great strides in smoke-free air, tobacco tax, and insurance coverage for privately insured and Medicaid populations – assisting the uninsured population is now the top priority to drive down smoking prevalence.

The uninsured in Colorado are similar to those nationwide – higher smoking rates, more in-home smoking, less access to treatment, and less success at quitting. Two thirds of the adult smokers in Colorado are in the lower socioeconomic strata. The touch points for the uninsured are emergency departments, federally qualified health clinics, and other safety net clinics, but cessation treatment is not likely to be offered through these channels, at present. Smoking related health costs for the state total $1.3 billion annually, including $300 million in Medicaid costs.

The Colorado team has held key informant interviews and roundtable meetings in addition to the state summit. The target groups involved are: 

• Medical providers/professionals serving the uninsured
• Mental health and substance abuse treatment providers and professionals
• Advocacy/policy organizations and funders serving the uninsured
• Cessation/addiction experts
• Media professionals with knowledge of reaching low income populations (focus on increasing utilization)
• Uninsured Coloradans
• Health plans
• Colorado health systems experts
• Workforce/employee/employer organizations serving/employing the uninsured

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?  

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

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

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  

ActiontoQuit is a tobacco cessation initiative sponsored by Partnership for Prevention. It urges all sectors - employers, insurers, health care systems, quitlines, and policymakers - to work together to ensure that all tobacco users have access to comprehensive cessation treatments.

Senior Program Officer for the Partnership for Prevention, David Zauche, recently spoke with the Smoking Cessation Leadership Center about current activities and future projects of ActionToQuit.  We posted part one of the interview last Monday, August 2.  Here is part two:

5. How does the [Save Lives and Money - Help People on Medicaid Quit Tobacco] guide address the passage of health reform for Medicaid and cessation coverage? For example: I understand the new health reform bill requires that all state Medicaid programs provide comprehensive tobacco cessation care to pregnant women. What are some of the recommendations in the guide for state Medicaid programs to implement these changes?

The passage of health reform will do much to advance tobacco cessation in the United States. Shortly, private health plans will be required to extend coverage of many clinical prevention services recommended by the U.S. Preventive Services Task Force. This coverage will include tobacco cessation interventions. All state Medicaid plans will be required to provide tobacco cessation coverage for pregnant women, but to them only. Partnership for Prevention and other national partners believe that this is the right time for states to voluntarily extend tobacco cessation coverage to all Medicaid beneficiaries, not just pregnant women. The six states I mentioned have done this because it made sense from the health promotion and fiscal angles. When people quit smoking successfully, they realize many health benefits. But states can benefit too.

6. Action to Quit has many cessation resources and partnership activities listed on the website. Are there specific resources Partnership offers around implementing tobacco free policy changes which you can share with our audience?

Three guides, all available for free download on www.actiontoquit.org, come to mind. "Smoke-Free Policies - An Action Guide" is a resource for workplaces and community leaders that want to establish ordinances to protect the public from secondhand smoke. It translates the evidence-based recommendations in "The Community Guide" into implementation strategies. "Investing in a Tobacco-Free Future" is a tool kit for the workplace. It outlines the costs of smoking to businesses, the impact on worker productivity, and how to implement tobacco use treatment policies through a health plan. "Investing in Health - Proven Health Promotion Practices for Workplaces" charts a course for businesses to implement three inexpensive strategies to save lives from tobacco. They are: implementing tobacco-free policies, offering tobacco use treatment benefits, and providing access to a telephone quitline for tobacco users.

7. What other tools and resources can people anticipate in the future?

Partnership for Prevention recently extended funding to the Joint Commission to develop and test a global set of tobacco cessation quality standards which would be applicable to all hospitalized patients. If adopted, these measures will require hospitals to identify all patients who use tobacco and offer them counseling, medications and limited follow-up. Later in 2010, when the final standards are published, Partnership will create and disseminate an implementation guide for hospitals. Additionally, Partnership will produce case studies for each of our funded ActionToQuit grantee states. These will describe their journey in forming a state tobacco cessation alliance, holding a summit meeting, and creating a state action plan to advance cessation.

8. What recommendations do you have for those interested in creating their own partnership around cessation or improving one that already exists?

Two things have been proven in recent years:

• First, the highly successful tobacco tax and smoke-free state campaigns have proven that tobacco control advocates can come together and, through a strong synergistic effort, change policies and save lives. It's happened across the country.
• Second, we've learned just recently that a state can cover all its Medicaid subscribers for tobacco cessation treatment and see positive short term results. Massachusetts implemented a comprehensive tobacco cessation benefit in July of 2006 and has seen smoking rates for beneficiaries drop 26% in two and a half years. The state has also seen significant decreases in hospitalizations for heart attacks, emergency room visits for asthma symptoms, and adverse maternal birth complications.


The ActiontoQuit Network is a group of over 500 professionals who are committed to tobacco cessation.

For more information contact:
Brandi Robinson at brobinson@prevent.org, 202-384-1505 or
David Zauche at dzauche@prevent.org, 202-375-7807.

ActiontoQuit is a tobacco cessation initiative sponsored by Partnership for Prevention. It urges all sectors - employers, insurers, health care systems, quitlines, and policymakers - to work together to ensure that all tobacco users have access to comprehensive cessation treatments.

Senior Program Officer for the Partnership for Prevention, David Zauche, recently spoke with the Smoking Cessation Leadership Center about current activities and future projects of ActionToQuit:

1. Could you tell us a about the ActionToQuit State Grant Program? Which States are recipients? What are the states striving to accomplish? How does the program play a part in Partnership’s mission?

ActionToQuit is Partnership for Prevention's tobacco cessation initiative. Partnership's mission is to be the nation's most trusted resource, educator and advocate for disease prevention and health promotion. To that end, ActionToQuit works through policy and system change to increase access to tobacco cessation treatments for all Americans. Our website is www.actiontoquit.org and we offer a free monthly tobacco cessation e-newsletter and listserv, both by subscription.

Partnership for Prevention awarded six ActionToQuit state grants in 2010 for the implementation of innovative strategies to advance to tobacco cessation, with funds used for the development of state alliances/summit meetings and the creation of strategic plans. The projects will involve various sectors that can impact access to tobacco cessation including employers, health care systems, insurers, quitlines, and policymakers. The state grant projects are:

• Colorado - Cessation Coverage/Treatment for Colorado's Uninsured

• Florida - Tobacco Cessation Summit & Action Plan

• Nevada - Increasing Cessation Access for All Nevadans

• New England - New England Partnership for Smoking Cessation Policy

• New York - New York State Access to Tobacco Use Treatment Strategic Planning Project

• Virginia - Virginia Partnership for Tobacco Use Cessation

A brief on each grantee's initiative has been posted to the ActionToQuit website here.

2. Your website offers some valuable resources for those interested in expanding access to tobacco cessation treatment. Could you tell us about the recent creation of Save Lives and Money - Help People on Medicaid Quit Tobacco? What was the history behind the creation of the guide?

Save Lives and Money - Help People on Medicaid Quit Tobacco is a new resource from Partnership and the American Lung Association. It's the second guide of its kind from these national partners, the first one dealing with state employee tobacco cessation coverage. This resource is important because of the high rates of tobacco use among the Medicaid population and the associated costs. The big idea is that because so much of Medicaid's funding goes toward tobacco-related diseases, an up-front investment in prevention (i.e. tobacco cessation) must be given serious consideration. In 2004, U.S. Medicaid expenditures for illnesses caused by tobacco totaled $30 billion, or 11% of the entire Medicaid budget. The point is that we must do more to help people on Medicaid quit tobacco - if we do we'll save both lives and money.

3. Why did you feel there is a need for such a resource?

ActionToQuit wants to spotlight the states that are doing the best job at providing Medicaid coverage for their tobacco users. The six states that lead the way by covering all treatments recommended by the U.S. Public Health Service are Indiana, Massachusetts, Minnesota, Nevada, Oregon, and Pennsylvania. In particular, we applaud their efforts to cover all medications and counseling treatments since most smokers will need many attempts and (possibly) several different tools to quit successfully.

4. What audience is the guide intended for?Partnership for Prevention believes that all Medicaid plans should be required to cover all cessation treatments. To this end the new guide is intended for advocates that comprise state tobacco control coalitions, insurers/health plans, state Medicaid leaders, and policymakers. States have achieved many outstanding advances in smoke free air laws and increased tobacco taxes and these accomplishments are to be commended. However, tobacco control policies related to cessation have often lagged behind. One area in which much progress is needed involves the unnecessary barriers that exist which make it harder for people to make quit attempts. Insurers and policymakers should focus on removing these barriers, which include co-pays, duration limits, annual limits on quit attempts, and dollar limits. There are policy solutions for these problems.

5. How does the guide address the passage of health reform for Medicaid and cessation coverage?

...to be continued: read part two of the interview this Thursday, August 5, 2010

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