Prevention Matters

"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

Doctors Urge Indoor Tanning Ban for Minors

U.S. tanning salons should close their doors to minors to protect them from skin cancer, a group of 60,000 pediatricians said Monday in a new policy statement. With the move, the American Academy of Pediatrics joins the World Health Organization (WHO), the American Academy of Dermatology and other groups that are already pushing for a ban. Since 2009, the International Agency for Research on Cancer, a part of the WHO, has classified tanning beds as cancer-causing. Research shows people who start going to tanning salons before age 35 have a 75-percent increase in their chances of developing melanoma, the deadliest type of skin cancer.

WORST

Smoking Linked to Infant Heart Defects


A pregnant woman who smokes in her first trimester is much more likely to have an infant with a congenital heart defect, U.S. health officials say.  A study by the Centers for Disease Control and Prevention in Atlanta found tobacco exposure is associated with a 20 percent to 70 percent increased risk of certain types of defects such as those that obstruct the flow of blood from the right side of the heart into the lungs and openings between the upper chambers of the heart.


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 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.

"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

Breast-Feeding May Counter Some Effects of Childhood Cancer

Breast-feeding may help reduce some long-term negative side effects of cancer treatment in women who survived childhood cancer, according to a new study.


The findings suggest that making women aware of the benefits of breast-feeding should be part of routine recommendations for a post-cancer healthy lifestyle, said Susan W. Ogg and colleagues from St. Jude Children's Research Hospital in Memphis, Tenn.

WORST

Smoking, Obesity Slowing U.S. Life Expectancy Gains: Report


Longevity isn't increasing as fast in the United States as it is in other developed countries, says a new report that points a finger at high rates of smoking and obesity.


For 25 years, U.S. life expectancy at age 50 has increased, but more slowly than in most of the other 21 countries studied, including Japan and Australia, notes the report from the National Research Council, an arm of the U.S. National Academy of Sciences.


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/.

"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

Study Shows Building Up to 10,000 Steps a Day May Lead to Weight Loss and Better Insulin Sensitivity

Building up to 10,000 steps a day can help control weight and may reduce diabetes risk, suggests new research in the journal BMJ.

Of 592 middle-aged Australian adults, those who increased the number of steps they took during a five-year period and built up to 10,000 steps per day had a lower body mass index, less belly fat, and better insulin sensitivity than their counterparts who did not take as many steps daily during the same time period. Of 592 middle-aged Australian adults, those who increased the number of steps they took during a five-year period and built up to 10,000 steps per day had a lower body mass index, less belly fat, and better insulin sensitivity than their counterparts who did not take as many steps daily during the same time period.


WORST

Smoking 'causes damage in minutes', US experts claim


Smoking damages the body in minutes rather than years, according to research in the US. The report, published in Chemical Research in Toxicology, shows that chemicals which cause cancer form rapidly after smoking.

Scientists involved in the small-scale study described the results as a stark warning to people considering smoking. Anti-smoking charity Ash described the research as "chilling" and as a warning that it is never too early to quit.

The long term impact of smoking, from heart disease to a range of cancers, is well known. This study suggests the damage begins just moments after the first cigarette is smoked.


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 study showing that children benefit from laws that regulate locations where smoking is allowed was named the “Best Prevention Idea of the Week,” while a study that found that loose infection practices are contributing to problems with infection control at same-day surgery centers was named the “Worst Prevention Idea of the Week."

BEST

Smoke-Free Laws Benefit Kids, Too

Kids benefit from laws that regulate locations where smoking is allowed, a new study shows.

Smoke-free-air laws have already been shown to reduce exposure to secondhand smoke among adults. Now a study shows that such laws benefit children and adolescents, too, as long as they don't live with a smoker.

Researchers analyzed data from the 1999-2006 National Health and Nutrition Examination Survey and found that youngsters who live in a county with extensive smoke-free-air laws had a 39% lower prevalence of cotinine in their blood. Cotinine, an alkaloid found in tobacco, is a major metabolite of nicotine and a common biomarker of secondhand smoke exposure. It is detectable in blood for a minimum of several days after exposure to tobacco smoke.

WORST

Poor infection control at many surgery centers


A new federal study finds many same-day surgery centers — where patients get such things as foot operations and pain injections — have serious problems with infection control. Failure to wash hands, wear gloves and clean blood glucose meters were among the reported breaches. Clinics reused devices meant for one person or dipped into single-dose medicine vials for multiple patients. The findings, appearing in last Wednesday's Journal of the American Medical Association, suggest lax infection practices may pervade the nation's more than 5,000 outpatient centers, experts said.

Massachusetts is poised to become the first state in the nation to force retailers to prominently display graphic warnings about the perils of smoking right where cigarettes are sold - at tobacco sales racks and next to cash registers. Images of ominously darkened lungs, damaged brains, and diseased teeth could start appearing before the end of the year in more than 9,000 convenience stores, pharmacies, and gas stations, if a proposal by the state Department of Public Health is approved as expected. Other posters would direct smokers to where they can get help to stamp out their habit.

''If somebody is trying to quit smoking and they go back to the store and they're tempted - oh, just one pack - we hope this will help them make a different choice,'' said Lois Keithly, director of the Massachusetts Tobacco Cessation and Prevention Program.

New York City implemented a similar campaign in December, where Anne Pearson serves as an attorney with the city's Bureau of Tobacco Control. ''There's a large body of evidence showing these graphic images are very effective,'' Pearson said. ''They can communicate information in a way that text just can't, and they can also communicate a message to people regardless of their level of literacy and regardless of the language they speak.''

The campaign is being underwritten by $316,000 in federal stimulus money from the Centers for Disease Control and Prevention, which will allow the state to provide the materials to retailers without charge.

David Zauche
Managing Senior Fellow and Senior Program Officer
Partnership for Prevention

According to a survey administered by the Virginia Foundation for Healthy Youth, one out of three teenagers younger than 18 mistakenly identified a new type of smokeless tobacco product as candy or gum. The survey of about 1,400 Virginia residents, including 728 younger than 18, asked them to identify package images for several types of new, smokeless tobacco products, as well as package images of mints and gums. About 39 percent of the respondents younger than 18 identified Camel Orbs, an oral tobacco product that dissolves in the month and delivers nicotine to the user, as mints or gum. Of the teenagers younger than 18 surveyed who do not currently use tobacco, 27 percent said they would try Camel Orbs based on packaging alone.

Another product identified in the survey was Stonewall, a type of smokeless, pellet tobacco sold by Star Scientific Inc. About 35 percent of the survey respondents 18 or younger perceived Stonewall to be candy, mints or gum. Twenty-three percent said they would try Stonewall because of the packaging.

The survey results suggest that packaging of the products alone may appeal to youth, said Danny Saggese, director of marketing for the Virginia Foundation for Healthy Youth."It poses a significant risk to youth and raises the possibility of them not only using these products, but using them in places where smoking is now prohibited, and potentially becoming nicotine addicts," he said.

In March 2010, the U.S. Food and Drug Administration issued a rule restricting access and marketing of cigarettes and smokeless tobacco products to youth. The rule becomes effective June 22, 2010 and will require smokeless tobacco products to have warning labels that cover one-third of the front and back of the packages. However, many tobacco prevention groups and government officials believe the FDA should ban smokeless tobacco products altogether. In an April 18th New York Times interview, U.S. Senator Jeff Merkley of Oregon called the products “tobacco candy,” noting that “everything about them is designed for kids.”

Brandi Robinson
Program Associate
Partnership for Prevention

The use of bar-code verification technology to decrease medication errors in hospitals was named the “Best Prevention Idea of the Week,” while misleading tobacco ads aimed at South Asian women was named the “Worst Prevention Idea of the Week."

The “Best/Worst” awards are announced each week in “Prevention Matters,” the blog of Partnership for Prevention. Nominees are submitted by Partnership staff as well as the general public, and are voted on by the staff. Partnership for Prevention is a nonpartisan organization of business, nonprofit and government leaders who are working to make evidence-based disease prevention and health promotion a national priority. More information is available at http://www.prevent.org/.

BEST

Bar-Code Technology Reduces Medication Errors in Hospitals

Use of bar-code verification technology can substantially decrease both transcription errors and medication administration errors in hospitals, according to research published in the May 6 issue of the New England Journal of Medicine. "Taken together, our findings show that the bar-code eMAR technology improves medication safety by reducing administration and transcription errors, providing support for the inclusion of this technology as a 2013 criterion for achieving meaningful use under the American Recovery and Reinvestment Act. Given challenges in implementing this technology, however, further research should focus on identifying factors that will lead to its optimal implementation," the authors write.

WORST

Tobacco firms take aim at Bangladeshi, Asian women

Bangladeshi chest doctor Kazi Saifuddin Bennoor has seen many misleading cigarette advertisements, but the one that suggested smoking could make childbirth easier plumbed new depths. Advertisements telling smokers they are smarter, more energetic and better lovers than their non-smoking counterparts are a familiar sight across Bangladesh — something unimaginable in most other countries. The promotion is being linked to an alarming rise in tobacco use in the impoverished South Asian country, particularly among women and the young — a trend repeated across many developing countries, anti-tobacco groups say.

An analysis of a large number of medical records of people born in Finland indicates a link between psychiatric illness and prenatal exposure to tobacco smoke. Mikael Ekblad, a doctoral student at Turku University in Finland, reported these findings at the meeting of the Pediatric Academic Societies. Children born to mothers who smoked while pregnant had a 44% increased risk of psychiatric drug use later in life, presumably because of psychiatric disorders.

It has long been known that maternal smoking can affect the placenta, often leading to low birth weight or prematurity, and some previous studies had demonstrated the link between mental illness and tobacco smoke in the womb.

Davide Zauche
Managing Senior Fellow and Senior Program Officer
Partnership for Prevention

Toronto’s ban on smoking in restaurants that led to a major decline in heart and lung hospital admissions was named the “Best Prevention Idea of the Week,” while the lack of progress in eliminating infections that can harm or kill patients in U.S. hospitals was named the “Worst Prevention Idea of the Week."

The “Best/Worst” awards are announced each week in “Prevention Matters,” the blog of Partnership for Prevention. Nominees are submitted by Partnership staff as well as the general public, and are voted on by the staff. Partnership for Prevention is a nonpartisan organization of business, nonprofit and government leaders who are working to make evidence-based disease prevention and health promotion a national priority. More information is available at http://www.prevent.org/.

Best

Smoking Ban Cut Hospital Admissions

Toronto's ban on smoking in restaurants led to a major decline in heart and lung hospital admissions, a Canadian medical research study said Tuesday. Smoking in restaurants was banned by the city in 2001. The research published in the Canadian Medical Association Journal said within three years, hospitalizations for heart conditions fell 39 percent and 32 percent for respiratory conditions, the Globe and Mail reported. Using data from two other regions in Ontario that didn't have smoking bans, the rate of admissions for heart attacks jumped by almost 15 percent during the same time period, the report said.

Worst

U.S. Hospitals Get Low Marks on Curbing Infections

U.S. hospitals are making little progress in eliminating infections that can harm or kill patients, according to reports released April 13 by the federal Agency for Healthcare Research and Quality. Researchers found that rates of bloodstream infections after operations (postoperative sepsis) increased by 8 percent, rates of catheter-associated urinary tract infections following surgery increased by 3.6 percent, and rates of certain infections due to medical care increased by 1.6 percent. However, rates of pneumonia that developed after surgery (postoperative pneumonia) fell by 12 percent.

The April 16, 2010 issue of the Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report includes data collected by the Adult Tobacco Survey (ATS) during February 2003 – November 2007. Among 33 ATSs conducted in 19 states, current cigarette use by adults ranged from 13.3% (Hawaii in 2006) to 25.4% (West Virginia in 2005), with a median of: 19.2%. Among young adults aged 18-29, current cigarette use ranged from 15.8% (Hawaii in 2006) to 40.4% (West Virginia in 2005), with a median of: 26.7%.

The survey also found that with the exception of smokeless tobacco use and pipe use, the median prevalence of current use of each tobacco product was consistently highest among adults aged 18-24 years and lowest among adults aged ≥65 years. Polytobacco use ¬– current use of multiple tobacco products including cigarettes, cigars, pipe tobacco or smokeless tobacco – was also explored in the survey. The percentage of adults using two tobacco products ranged from 10.6% (South Carolina in 2007) to 18.6% (Oklahoma in 2004) (median 14.5%). The percentage of adults using three tobacco products ranged from 1.6% (South Carolina in 2007) to 4.6% (Ohio in 2006) (median 2.9%). The percentage of adults using all four tobacco products ranged from 0.0% (Iowa in 2004, Oklahoma in 2004, and South Carolina in 2007) to 0.6% (Georgia in 2004) (median 0.3%).

Adults who were employed for wages or self-employed were asked whether their employer had offered any programs to help them stop smoking or any other types of help to employees who wanted to quit smoking. Among 12 ATSs, the percentage of adults (smokers and nonsmokers combined) who reported that their employer offered any cessation programs ranged from 19.7% (New Mexico in 2003) to 28.6% (South Carolina in 2007) (median: 23.4%). The percentage of current smokers who reported employer-offered smoking cessation programs ranged from 13.5% (Idaho in 2005) to 22.5% (Iowa in 2006) (median: 18.4%).

Based on the results of the survey, CDC recommends that states establish, maintain, and fund comprehensive tobacco control programs, at least at CDC-recommended levels, to reduce tobacco-related deaths and diseases. CDC regularly evaluates the recommended state ATS questions with a goal of more closely aligning the questions with short-term, intermediate, and long-term outcome indicators to measure progress toward National Tobacco Control Program goals.

The Adult Tobacco Survey is a random-digit--dialed telephone survey of the civilian, noninstitutionalized U.S. population aged ≥18 years that collects data on tobacco use, smoking cessation, secondhand smoke exposure, risk perception and social influences, health influences, and tobacco-related policy issues in the United States.

Brandi Robinson
Program Associate
Partnership for Prevention

More U.S. smokers than ever are utilizing telephone quitlines to help them stop smoking. However, budget cuts are now limiting access to this critical service according to a report released today by the North American Quitline Consortium and other public health organizations.

"At a time when demand for quitlines is at a record level, it is more important than ever to support proven tobacco cessation efforts,” said Linda Bailey, president and chief executive officer of the North American Quitline Consortium (NAQC). "The investment of $2.19 per capita for quitlines, as recommended by the Centers for Disease Control and Prevention, is based on sound science and real-world experience. States that made the necessary investments have been able to provide cessation services to the growing number of smokers who want to quit. We commend the states that have committed the necessary funding to quitline services and encourage them to continue this practice."

The number of tobacco users calling quitlines—a telephone helpline where smokers can turn for trusted, reliable help when they want to quit—increased 116% between 2005 and 2009, according to the report. Despite this increase in demand, total funding for all U.S. quitlines decreased for the first time ever in Fiscal Year (FY) 2010. Funding has been cut despite the fact that states will collect $25.1 billion in revenue this year from tobacco taxes and legal settlements with the tobacco industry, and more states have already enacted or are considering tobacco tax increases this year. These increases will motivate more smokers to try to quit and provide additional revenue that states can use to fund quitlines and other tobacco prevention and cessation programs.

David Zauche
Senior Program Officer
Partnership for Prevention

The United States is continuing to make great strides toward the elimination of tobacco smoke in the country’s air. According to the Americans for Nonsmokers’ Rights Foundation, as of April 1, 2010, 32 states, along with Puerto Rico, the Northern Mariana Islands, and the District of Columbia have strong state/commonwealth laws in effect that qualify for at least one of the 100% smokefree list categories (workplaces, restaurants, and/or bars). A total of 38 states and the District of Columbia now have 100% smokefree air laws in effect at the local level. Adding to this growing list, by July 5, 2010, Michigan, Kansas and Wisconsin will all be 100% smokefree. More specifically, 57.2% of the U.S. population now lives in cities or states with smokefree non-hospitality workplaces; 68.1% in areas with smokefree restaurants; and 57.1% in areas with smokefree freestanding bars. Forty-one percent of the population is currently protected in all three categories.

For more smokefree lists, maps and reports visit Americans for Nonsmokers' Rights.

Alex Einhorn
Policy and Program Intern

The newly-established FDA tobacco advisory panel has the opportunity to take a bold step and ban menthol cigarettes. Menthol cigarettes are popular with young smokers -- 62 percent of middle-school smokers begin with menthol cigarettes. And, about 75 percent of African American smokers use menthol brands. These two groups are heavily targeted by tobacco companies, which says menthol cigarettes are no more dangerous than other cigarettes. But, Congress and the FDA had no problem banning other favors like chocolate and clove. What’s the big deal here? How about $18 billion dollars a year? The tobacco industry won’t give up on menthol without a strong fight. Health advocates need to continue to make the case for a ban.

Read the Washington Post article on menthol - "FDA panel mulls putting limits on menthol cigarettes".

Diane Canova
Vice President, Policy and Programs

The announcement by PepsiCo that it plans to remove sugary drinks from schools worldwide was named the “Best Prevention Idea of the Week,” while women in Wales smoking during their pregnancy has been named the “Worst Prevention Idea of the Week.”

The “Best/Worst” awards are announced each week in “Prevention Matters,” the blog of Partnership for Prevention. Nominees are submitted by Partnership staff as well as the general public, and are voted on by the staff. Partnership for Prevention is a nonpartisan organization of business, nonprofit and government leaders who are working to make evidence-based disease prevention and health promotion a national priority. More information is available at http://www.prevent.org/.

BEST

PepsiCo to stop selling sugary drinks from schools worldwide by 2012

PepsiCo plans to remove sugary drinks from schools worldwide, following the success of programs in the U.S. aimed at cutting down on childhood obesity. The company said last Tuesday it will remove full-calorie, sweetened drinks from schools in more than 200 countries by 2012, marking the first such move by a major soft drink producer.

WORST

One in five women in Wales smoke while pregnant


Wales has the highest rates of women who smoke during their pregnancy in the UK, shocking figures revealed. Despite the social taboo, the figures from anti-smoking charity ASH Wales show one-in-five women continue to smoke throughout pregnancy. Midwives said many young women are smoking while pregnant because they believe they will have smaller “doll-like” babies.

In a wide-ranging interview (“Michelle Obama: No longer a 'caricature”) published today in Politico, the First Lady “addressed a doctors’ report that the president is still smoking, saying he has found it difficult to quit amid the rigors of the presidency.”

“What the president struggles with is what every smoker struggles with, it’s a difficult habit to break. It’s understandable that he struggles with it. Do I want him to stop completely? Absolutely. And I will push him to do so, but it’s a process,” Michelle Obama said.

“I’ve never been a smoker so I can’t relate, but people who’ve smoked say like anything, you have dips and valleys, and to try to quit smoking in one of the most stressful times of the nation’s history is sort of like, you know, OK, he’s going to struggle a little bit. This may be the year he’ll struggle,” she said.

We know that quitting smoking is tough work. It takes persistence. That is why Partnership for Prevention and its ACTTION initiative are working to assure that health reform continues to include coverage and access to comprehensive smoking cessation services. But, no less important to successfully quitting, is having the kind of supportive family and workplace environment that is available to the President. I’m not worried about the President. With Michele in his corner he’ll get there.

Posted by:
Ripley Forbes
Director, Government Affairs, Partnership for Prevention

At the recent health summit in Washington, President Obama repeatedly emphasized his commitment to pass meaningful health reform. Despite strong opposition from Republicans in Congress, President Obama is showing the mettle he demonstrated throughout the 2008 campaign. He isn’t giving up and he won’t back down. His commitment to insurance reform and extending high quality health coverage, including access to vital clinical preventive services to millions of uninsured Americans shows courage and character.

But the issue of smoking is one where we value quitters. According to press reports President Obama’s recent physical revealed that he continues to struggle to quit smoking. Most smokers have trouble quitting tobacco so the President’s situation is not unusual. It is ironic that the President who has done so much to protect children from tobacco, and through health reform, increase the availability of tobacco cessation therapies, would struggle to win his personal cessation campaign. But Obama is human and difficulty quitting tobacco is an all too common experience among the millions of smokers who try to quit each year.

Writing in the March 1st Christian Science Monitor, Ron Scherer notes that “anti-smoking advocates view the president’s cigarette struggles not so much as a setback, but rather as an opportunity to try to get more Americans to quit. And they place more importance on his desire to snuff out his tobacco usage than on his success in those efforts.”

Now that’s something we should all be able to agree with. That the President has struggled to quit smoking underscores why it is so important that insurance plans, employers, friends and family members do all they can to support and encourage smokers seeking to quit what is all too often a lifelong and life threatening addiction.

A CBS TV News Healthwatch segment (“Up in Smoke”) added important commentary from medical correspondent and physician Jennifer Ashton. Dr. Ashton cautioned that most former smokers find success only after trying to quit multiple times. She urged that smokers take advantage of available treatments including counseling, OTC nicotine replacement products and prescription medications. Ashton said the decision to quit smoking is really “a life or death issue and the single most important thing you can do for your health.”

Good advice for the public…and for our President.

Posted by:
Ripley Forbes
Director, Government Affairs, Partnership for Prevention

The U.S. Department of Health and Human Services (HHS) has awarded more than $119 million to states and U.S. territories to support public health efforts to reduce obesity, increase physical activity, improve nutrition, and decrease smoking-the four most important actions for combating chronic diseases and promoting health. This money supports the one of several components in the Department's comprehensive prevention and wellness initiative, Communities Putting Prevention to Work, which is funded under the American Recovery and Reinvestment Act of 2009.

A new study in the American Journal of Preventive Medicine suggests that people respond well to free counseling programs on weight loss or smoking cessation, but participation falls dramatically when services are no longer free. The cost of counseling also appears to make a difference to the doctors or health-care providers who refer patients to the programs, according to the study.

The authors reviewed a program that used an electronic database system to suggest health-care counseling for adults with unhealthy behaviors. For a time, free counseling was provided until funding ran out. Under the free program, 1,860 of 5,679 people who were evaluated were determined to have at least one unhealthy habit, and 407 of them were given referrals for intensive counseling, the study reported.

After the funding ceased, 729 of 2,510 people who were evaluated were determined to have unhealthy habits and just five were referred for counseling -- a 97 percent decrease in the referral rate, according to the study. Even when clinicians did offer a referral, 81 percent fewer patients followed through and got counseling when the counseling was not free.