Prevention Matters

The Centers for Disease Control and Prevention (CDC) has over 100 E-Cards with healthy messages about smoking cessation, heart health, women’s health and many more. Send one to your mom for Mother’s Day to show her how much you care about her and her and wellbeing.

"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

Smokers Urged to Join Thursday's Great American Smokeout

Get ready, get set, quit! Thursday marks the annual Great American Smokeout, sponsored by the American Cancer Society, which urges all smokers to lay off the habit for at least 24 hours. There have been dramatic changes in attitudes about smoking and a large decrease in smoking rates since the Smokeout was first held in 1977. The annual event includes local and nationwide events meant to encourage smokers to quit for at least one day in the hope that they may decide to permanently kick the habit. The Smokeout has helped focus attention on the dangers of tobacco use and contributed to a "cultural revolution" in tobacco control, says the American Cancer Society. Between 1978 and 2009, the percentage of adults who smoke in the United States fell from 34 percent to 21 percent, according to the U.S. Centers for Disease Control and Prevention (CDC).


WORST

Number of Uninsured Rises, Report Says


The number of uninsured adults in the United States continues to rise, with one in four adults under 65 reporting they were without health insurance at some point in the last year, according to a recent report from the federal Centers for Disease Control and Prevention.  About 50 million adults said they were uninsured for at least some time. The report is based on a survey conducted between January and March.


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 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

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

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

A new study published in the British Medical Journal states that smoking cessation offers a significant benefit to early-stage lung cancer patients by reducing the progression of the disease.
“The adjusted estimates suggest that the risk for death is halved in patients who stop smoking”, say the researchers, led by Amanda Parsons, research fellow at the UK Center for Tobacco Control Studies at the University of Birmingham, United Kingdom.

“The difference in survival between patients who stopped smoking and those who continued is striking", said H. Jack West, MD, medical oncologist at the Swedish Cancer Institute in Seattle, Washington, and author of the Blowing smoke blog on Medscape Oncology. “This effect is larger than that seen with postoperative chemotherapy”, he added.

This research is both fascinating and promising, but must be considered preliminary. Only a large-scale randomized controlled trial will permit researchers to confidently draw conclusions and make patient care recommendations.

David Zauche
Senior Program Officer
Partnership for Prevention