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?  

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.

The success of a recent Massachusetts program hat provides virtually free access to tobacco cessation treatments has left CDC officials shocked and encouraged lawmakers to look at expanding the approach nationwide.

When the program was launched two years ago, about 38 percent of poor Massachusetts residents smoked. By 2008, the smoking rate for poor residents had dropped to about 28 percent, a decrease of about 30,000 people in two and a half years, or one in six smokers. There are also indications that the drop has lowered rates of hospitalization for heart attacks and emergency room visits for asthma attacks, she said.

Senators Richard J. Durbin of Illinois and Bernard Sanders of Vermont have introduced an amendment that would provide similar new Medicaid coverage for tobacco addiction as nationwide, and the Senate could vote on it by the weekend. If the amendment fails, Senator Tom Harkin of Iowa said he would try another avenue: seeking an expansion through a conference committee that will ultimately reconcile the House and Senate bills.

"We should be able to find an opening," Mr. Harkin said in an interview. "This is one demonstrable way we can actually bend the cost curve and keep people healthy."

Terry F. Pechacek, associate director for science for the CDC's Office on Smoking and Health, told the New York Times that he found the numbers “shocking,” since smoking rates around the nation have barely budged since 2004. He said the U.S. smoking rate has only decreased from 20.9 percent in 2004 to 20.6 percent in 2008, while smoking-related illnesses cost the Medicaid system more than $22 billion a year - or about 11 percent of overall Medicaid expenditures.

Pechacek says if the federal health care overhaul includes smoking-cessation coverage, publicizing it will be as crucial to its success as the cessation tools themselves.

"Even in the some of the states that offer wider coverage,” he said, “there’s been minimal promotion. People have to know about a benefit for it to have an effect.”

A “model” tobacco cessation benefit offered to Massachusetts’ Medicaid participants has produced an astounding 26% drop in smoking rates in only two and a half years, and has already been linked to decreases in heart attacks, hospitalizations for asthma and COPD, and a significant decrease in birth complications.


Researchers from the Massachusetts Tobacco Cessation and Prevention Program (MTCP) found that up to 38% fewer MassHealth cessation benefit users were hospitalized for heart attacks in the first year after using the benefit, and that 18% fewer benefit users visited the emergency room for asthma symptoms in the first year after using the benefit. Researchers also found that there were 12% fewer claims for adverse maternal birth complications since the benefit was implemented.

The Massachusetts Executive Office of Health and Human Services said more than 75,000 people – a full 40% of MassHealth members who smoke – have used the benefit to try to quit smoking. Cost savings are being studied, and all indications suggest they will be significant.

“As the nation debates the future of its health care system, the national significance of this research cannot be understated.” said Robert J. Gould, PhD, President and CEO of Partnership for Prevention. “These findings demonstrate that prudent investments in preventive health today will have a dramatic and positive effect on our health care system tomorrow.”

A creative contest that helped pay for a New England high school’s prom in return for student’s pledges not to tan for it was named the Best Prevention Idea of the Week, while an amendment passed by the U.S. Senate gutting the District of Columbia’s ability to restrict the use of firearms was named the Worst Prevention Idea of the Week.

The Best/Worst honors are a regular feature of Prevention Matters. Each week, Partnership for Prevention's staff will choose the designees based on nominations of items in the previous week’s news submitted by members, staff and the public at large. To submit a nomination or for more information, contact Damon Thompson at dthompson@prevent.org.

BEST IDEA

High School Wins $1,000 for Not Tanning

Over 500 Waltham, MA, High School students promised not to tan for this year's prom - and it paid off. As part of the Your Skin is In contest, the school won $1,000 from the Melanoma Foundation of New England to use toward the spring dance. The nonprofit, dedicated to education about early detection and prevention of melanoma, asked students across New England to sign a no-tanning pledge. Schools that got at least 70 percent of their prom-going class to sign the pledge were entered into a raffle with a chance to win $1,000 or $500 in prizes and tickets to Six Flags New England. Over 5,500 students across New England signed the pledge. Schools that got at least 70 percent of their prom-going class to sign the pledge were entered into a raffle with a chance to win $1,000 or $500 in prizes and tickets to Six Flags New England. Over 5,500 students across New England signed the pledge.


WORST IDEA

Senate approves amendment gutting DC gun restrictions

District of Columbia residents would have far greater access to firearms, including semiautomatic weapons, under a measure approved recently by the U.S. Senate. The 62-36 vote was a victory for the pro-gun lobby which has waged a lengthy battle against the tough antigun laws imposed by the district on its residents. Sen. John Ensign, R-Nev., offered the measure as an amendment to legislation giving the district a vote in the House of Representatives. The Brady Campaign to Prevent Gun Violence, in protesting the amendment, said it would allow D.C. residents to cross state lines to buy handguns in neighboring states and would repeal the district's ban on military-style weapons, including sniper rifles that can pierce armor plating. It would lower from 21 to the federal limit of 18 the age when people can possess handguns and ease the district's registration requirements.