Prevention Matters

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.

Earlier this week leaders from six of the nation’s most respected public health organizations expressed concerns about a recommendation to “move the majority of all tobacco related research at the NIH into a proposed addiction institute…” In a letter to NIH Director Dr. Francis Collins, the American Cancer Society, American Heart Association, American Lung Association, Campaign for Tobacco-Free Kids, LEGACY and Partnership for Prevention stressed that the proposed move “poses considerable risks to the ongoing efforts by the Department of Health and Human Services to reduce tobacco use.”

The November 2nd letter was sent in response to recommendations of the NIH’s Scientific Management Review Board which recommended the merger of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA). Historically, leadership on tobacco research has been championed by the National Cancer Institute and the National Heart, Lung and Blood Institute. Additionally, neither NIAAA nor NIDA have a significant tobacco research portfolio. The proposed merger of NIAAA and NIDA did not specifically assess the scientific value of transferring the tobacco research portfolios that have driven much of the our nation’s successful policy work and cessation advances over the past thirty years. The letter notes that transfer of tobacco research from NCI and NHLBI to a new entity generally unfamiliar with tobacco science will “create uncertainly about future funding for tobacco-related research…(i)t would also convey the impression … that the NIH considers the tobacco problem solved or that it is now less important to NIH.”

These leaders make a thoughtful and compelling case that removal of tobacco research from the protection and guidance of NCI and NHLBI is premature. In the absence of carefully study, such a move potentially endangers the nation’s continued progress to reduce tobacco use and help the Food and Drug Administration develop and execute a research agenda that will support its life saving regulatory mandates. This issue could have a profoundly negative impact on the quality and relevance of the excellent tobacco work currently underway in NIH’s flagship institutes.

The letter urges Dr. Collins to “postpone any action to include tobacco-related research in the proposed new institute” and to “initiate a review of (NIH’s) current tobacco research portfolio and determine what additional research is necessary to fully support the Administration’s efforts to reduce tobacco use. Such a review would also help inform your decision about whether a reorganization of tobacco research is appropriate.”

There is an old wisdom ... “if it ain’t broke…don’t fix it.” Tobacco continues to represent the nation’s leading cause of premature death and preventable illness. We have made remarkable progress in the decades since Surgeon General Luther Terry alerted the nation to the adverse health effects of smoking. Now is not the time to endanger continued progress in the vital public health work that NCI and NHLBI led tobacco research has supported over the decades. Requesting a thorough study of this issue seems a reasonable course of action for Dr. Collins to endorse.

E Ripley Forbes
Director, Government Affairs

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

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 American Lung Association is releasing its second annual "Helping Smokers Quit: State Cessation Coverage" report. The report addresses state coverage of cessation treatments through Medicaid, state employee health plans, private insurance, and quitlines in 2009. It shows that states are not doing enough to help smokers quit, when they could be saving lives and money by doing so.

Currently, only six states provide comprehensive coverage for Medicaid recipients: Indiana, Massachusetts, Minnesota, Nevada, Oregon and Pennsylvania. Just five states provide comprehensive cessation coverage for state employees: Illinois, Maine, Nevada, North Dakota and New Mexico.


The Lung Association recommends that private insurance plans also offer comprehensive cessation coverage and encourages states to require all insurance companies to cover these treatments. Currently, only seven states (Colorado, Maryland, New Jersey, New Mexico, North Dakota, Oregon and Rhode Island) have such requirements.

This lack of comprehensive cessation coverage in most states leaves smokers without clinically-proven treatment options when they want to quit.

The report makes recommendations on how to provide all smokers with access to cessation treatments in health care reform, and urges policymakers to provide this coverage. It also calls on each state to provide all Medicaid recipients and state employees with comprehensive, easily-accessible tobacco cessation medications and counseling. Finally, it recommends that private insurance plans offer comprehensive cessation coverage and encourages states to require all insurance companies to cover these treatments.

You can download the report here, and you can find detailed, state-specific information on cessation coverage through an online State Tobacco Cessation Coverage Database.

Only two states passed comprehensive smokefree laws in 2008, while only three states and the District of Columbia raised their tobacco taxes, according to a new report from the American Lung Association.

Stephen J. Nolan, American Lung Association National Board Chairsaid the results indicated that "the significant momentum previously achieved with the passage of smokefree workplace laws stalled during 2008."

To date, 24 states and the District have passed comprehensive smokefree laws as part of the American Lung Association's Smokefree Air challenge.

Tobacco is still the leading cause of preventable death in the U.S. today, but we may have some real opportunities to make substantial progress in changing that. Increases in federal and state tobacco taxes combined with mass education campaigns are sending a record number of people to telephone quitlines seeking advice on how to stop smoking. We’ll be discussing these factors with Paul Billings, Vice President for National Policy and Advocacy at the American Lung Association.