Prevention Matters

Partnership for Prevention published a state case study telling the story of Colorado’s journey toward comprehensive tobacco cessation coverage. Entitled “A Collaborative Approach to Meeting the U.S. Preventive Services Task Force Recommendations on Tobacco Cessation Screening and Intervention”, it describes how the Colorado Tobacco Cessation and Sustainability Partnership worked closely with public and private health plans to provide coverage for tobacco treatment. As a result, the majority of Colorado smokers have access to free or low-cost evidence-based cessation services and support for the state’s QuitLine has been enhanced. Advances were made in spite of decreased state tobacco control program funding.

Leaders in many states have begun to work with health plans to discuss the provision of preventive services. As the implementation of federal health reform moves forward it is Partnership’s hope that states can benefit from Colorado’s pioneering work in advancing tobacco cessation treatment. As states and territories progress toward a more integrated approach to preventive health, the Colorado Tobacco Cessation and Sustainability Partnership model for engaging health plans to implement USPSTF recommendations for cessation coverage can be applied to other preventive health services.

The U.S. Food and Drug Administration Tobacco Products Scientific Advisory Committee (TPSAC) recently concluded that the “removal of menthol cigarettes from the marketplace would benefit public health in the United States.”  This recommendation to the FDA is based on prevailing science surrounding menthol cigarettes.  Although menthol cigarettes do not contain more toxins, they increase the number of young people who try cigarettes and the number of children who become regular smokers, increasing overall youth smoking.  Menthol cigarettes have also been found to be more appealing to African-Americans and therefore contribute to higher smoking rates and decreased cessation among this population.

The TPSAC final report is set to go through a systematic review by experts from the FDA Center for Tobacco Products.  They are to take into account menthol cigarettes’ risks and benefits to the population, effects on overall smoking initiation and cessation rates, achievability, and consequential effects that may arise, such as demand for contraband.  The FDA intends to provide its first progress report on the review in about 90 days.

Partnership for Prevention supports the TPSAC’s recommendations and urges the FDA to take action to ban menthol to curb the uptake of smoking by youth and promote cessation among other high-risk groups.  The tobacco industry’s incessant marketing of menthol cigarettes to youth, African Americans and other communities are threats to the public’s health.  We are hopeful that the FDA will recognize the harmful impact of menthol cigarettes on the health of the nation and employ the committee’s advice.

Harmeet Singh
Tobacco Control Team

As one of the most popular sports in the United States, baseball is a highly integral and influential part of American culture today. Unfortunately, tobacco companies thrive on Major League Baseball players, who are the most prominent spokesmen for smokeless tobacco. The very heroes that many people, especially young kids, look up to are conveying a dangerous message that promotes a behavior that leads to mouth diseases, cancers, and heart attacks.

Despite the sufferings of Babe Ruth and Tony Gwynn with cancer, MLB players, coaches, and managers continue to chew tobacco all season long. It doesn’t seem like a coincidence that smokeless tobacco use among high school boys has increased by 36% in the past seven years.

In a January article in the Washington Post, Washington Nationals superstar pitcher Stephen Strasberg recalls how he began using smokeless tobacco as a teenager to better emulate the ballplayers he idolized. Strasberg is attempting to quit tobacco and his goal was to be tobacco free by spring training. Not only is Strasberg quitting because of the many health risks associated with tobacco use, but he also doesn't want kids who want to be like him to see him chewing.

The Campaign for Tobacco Free Kids and nine supporting organizations are calling upon MLB and the Players Association to ban all tobacco use on the field and in the dugout in their upcoming contract negotiations. The contract to be signed will be in place for five seasons, so taking action now is crucial.

Tobacco use has already been banned in the minors, the NCAA and the National Hockey League. It is time that MLB does the same.

Join the Campaign’s efforts to Knock Tobacco Out of the Park by sending a message to Major League Baseball denouncing smokeless tobacco.


Harmeet Singh
Tobacco Control Team

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 submit these comments to the U.S. Food and Drug Administration in regard to required textual warnings and accompanying graphics to be displayed on cigarette packages and in cigarette advertisements.

Partnership commends the FDA on the development of the new graphic health warnings. We urge the FDA to proceed with the implementation of the warnings without delay. The tobacco industry will inevitably work to impede and overturn the plans for the new health warnings on cigarette packages and advertisements, to take effect 15 months after issuance of this final rule. However, it is crucial that the FDA stay the course. According to the Centers for Disease Control and Prevention, an estimated 46 million people (aged 18 years and older) in the United States currently smoke cigarettes. Each day in the U.S., approximately 3,450 young people between 12 and 17 years of age smoke their first cigarette, and an estimated 850 youth become daily cigarette smokers. These statistics make it clear that more needs to be done to reduce the initiation of tobacco use and the prompt enforcement of this Family Smoking Prevention and Tobacco Control Act requirement will be a step in the right direction. These graphic health warnings will not only help young people to never start smoking, but also be beneficial in helping adults to quit.

Partnership for Prevention also strongly supports that 1-800-QUITNOW be required on all cigarette packages as a way to offer help to smokers who want to quit. A report released by the North American Quitline Consortium in 2010 showed that the total number of tobacco users accessing quitline services in FY 2009 was 515,000 (representing 1.2 percent of smokers), an increase of 129.7% over the FY 2005 level of 224,000. Quitlines are being used now more than ever so including the national access number on cigarette packages would be a simple and practical way to aid smokers who want to quit.

We thank you for the opportunity to comment on the cigarette warning labels and for your consideration of our views. Please contact David Zauche, Managing Senior Fellow & Senior Program Officer, at (202) 375-7807 or dzauche@prevent.org for further information or assistance.

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

"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/.

"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

FDA Proposes Graphic Warnings on Cigarette Packs

A series of gruesome pictures depicting emaciated lung cancer patients, a dead body in a morgue, a baby confined to a respirator (presumably the result of secondhand smoke) and other consequences of smoking that will appear on the outside of cigarette packages will hopefully shock people into quitting the habit or not starting in the first place, U.S. officials announced Wednesday, November 10.


WORST

Florida researcher looks for answers to alarming suicide rate among soldiers


American soldiers are killing themselves at the highest rate since the U.S. Military started keeping records and the trend is getting worse.

Military leaders say they are desperate to take action on the problem so the federal government is awarding a $17 million grant to Florida State and the Denver Veterans Affairs Medical Center for a suicide prevention program.

FSU's Professor Thomas Joiner is an internationally renowned expert on suicide who will help lead the military's effort to prevent suicides.

Joiner says there's a new trend of suicide in the military. The suicide rate among soldiers used to be lower than the general population. Joiner says now it's higher at an average of 12.5 suicides per 100,000 soldiers.


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/.

Wow….New graphic cigarette health warnings … FDA wants to know what you think.

At a press conference this morning (November 10, 2010) Health and Human Services Secretary Kathleen Sebelius helped unveil a “comprehensive tobacco control strategy that includes proposed new bolder health warnings on cigarettes and advertisements. In 2009 President Obama signed into law the “Family Smoking Prevention and Tobacco Control Act” (Public Law 111-31) which required that the Food and Drug Administration add “nine new larger and more noticeable textual warning statements and color graphic images depicting the negative health consequences of smoking.” The Notice of Proposed Rule Making includes 36 proposed images that are a remarkable and long overdue improvements over the warnings Congress required on cigarette packages and advertising ,back in 1984. The FDA is also conducting an extensive 18,000 person consumer test of the proposed graphic images to help identify the nine that will most effectively help current smokers quit and discourage potential new smokers from starting. The results of the FDA’s consumer research will also be released shortly and public comment will be solicited.

The current deadline for public comment on the proposed 36 images is January 9, 2011. The wording of the nine warnings was specified by the Congress when it enacted Public Law 111-31. These warnings include:

‘‘WARNING: Cigarettes are addictive."
‘‘WARNING: Tobacco smoke can harm your children."
‘‘WARNING: Cigarettes cause fatal lung disease."
‘‘WARNING: Cigarettes cause cancer."
‘‘WARNING: Cigarettes cause strokes and heart disease."
‘‘WARNING: Smoking during pregnancy can harm your baby."
‘‘WARNING: Smoking can kill you."
‘‘WARNING: Tobacco smoke causes fatal lung disease in nonsmokers."
‘‘WARNING: Quitting smoking now greatly reduces serious risks to your health."

The challenge for the FDA is to identify graphic images that best amplify the statutorily mandated wording of the cigarette warnings. Federal law also requires that the warnings and graphic images make up the top 50 percent of the front and back of cigarette packages.

FDA Commissioner Margaret Hamburg said it best: “When the rule takes effect, the health consequences of smoking will be obvious every time someone picks up a pack of cigarettes. This is a concrete example of how FDA’s new responsibilities for tobacco product regulation can benefit the public’s health.

So….take a few minutes to check out the FDA’s proposed new labels.

If you have family and friends who smoke…show them the new labels… get their advice and then tell the FDA.

The FDA has given us all an opportunity to play an important role, individually and collectively, in fighting the nation’s leading cause of premature death and preventable illness. Stronger health warnings, especially if they are accompanied by the 1 800 QUIT NOW cessation number, can help more smokers get access to effective cessation medications and discourage thousands of young people from striking the first match of what can become a lifelong, life threatening addiction.

Lets get to work. Tell the FDA what you think.


E Ripley Forbes
Director, Government Affairs

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

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

This ActionToQuit summit was an excellent first step toward the alliance’s goal of making Colorado the best state in the USA for tobacco cessation treatment.

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?  

The results were remarkable. Over a thirty month period 75,000 Medicaid subscribers in Massachusetts used the tobacco cessation benefit, and 33,000 quit smoking. The smoking rate for this population dropped from 38% to 28%, representing a 26% decrease. Additionally, significant decreases were seen in hospitalization rates for heart disease.

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  

This week’s Morbidity and Mortality Weekly Report (MMWR) was dedicated to new and disappointing findings in tobacco control. In addition to the article on secondhand smoke exposure, referenced in a Partnership blog posted yesterday, the Centers for Disease Control and Prevention also published, “Vital Signs: Current Cigarette Smoking Among Adults Aged ≥ 18 Years – United States, 2009.” Researchers at the CDC used data from the 2009 National Health Interview Survey and the 2009 Behavioral Risk Factor Surveillance System to determine adult smoking prevalence rates on both the national and state level.

Researchers found that in 2009, 20.6% of adults in the U.S. were current smokers. For the purposes of this study, cigarette smokers were defined as “adults aged ≥ 18 years who reported having smoked ≥ 100 cigarettes in their lifetime and now smoke every day or some days.” Among these smokers, 78.1% reported smoking every day and 21.9% reported smoking on some days. Results also showed that smoking prevalence varied greatly among different subgroups of the population. Men (23.5%) had a higher smoking prevalence than women (17.9%); non-Hispanic whites (22.1%) and non-Hispanic-blacks (21.3%) had a higher smoking prevalence than Hispanics (14.5%) and Asians (12.0%); and smoking prevalence was higher in the Midwest (23.1%) and South (21.8%) and lowest in the West (16.4%). In addition, there were great variations in smoking prevalence rates among individuals with different education levels. Overall smoking prevalence was found to generally decline with increasing education. Nearly half of all adults who obtained a General Education Development certificate were current smokers, while (49.1%) compared to 5.6 %of people with a graduate degree (5.6%). Researchers also found smoking prevalence to be higher among those living below the federal poverty line (31.1%) than among those at or above the poverty level (19.4%).

The 2009 smoking prevalence rate of 20.6% means that we will not be able to meet our Healthy People 2010 goal of reducing adult smoking prevalence to less than 12%. Results from this study also show that having any decline in smoking prevalence among adults is unlikely since data analyzed in this study show that declines have stalled during the past five years, with no significant difference between smoking prevalence rates in 2005 (20.9%) and 2009 (20.6%).

Partnership for Prevention believes this report provides significant evidence to support the notion that more efforts are needed to help reduce the prevalence of this leading cause of morbidity and mortality in the U.S. A closer look at various subgroups reveals that we have many disparities we need to focus our tobacco control efforts on, such as education and income level, in order to drive smoking prevalence down. Partnership for Prevention advocates for price increases, comprehensive smoke-free policies, and anti-tobacco media campaigns in addition to ensuring that all smokers have access to tobacco cessation treatment they need to quit.


Katie Burggraf
Tobacco Control Intern
Partnership for Prevention

A person’s decision to light up can have serious consequences for their health, but also for the health of those around them. Secondhand smoke is known to cause heart disease and lung cancer in nonsmoking adults but also to cause sudden infant death syndrome, acute respiratory infections, middle ear disease, exacerbated asthma, respiratory symptoms, and decreased lung function in children. Given these health hazards, how effective are our nation’s safeguards at preventing this secondhand exposure?

This week’s Morbidity and Mortality Weekly Report (MMWR), “Vital Signs: Nonsmokers’ Exposure to Secondhand Smoke – United States, 1999-2008,” provides the answer to this question by determining the proportion of the nonsmoking population who are exposed to secondhand smoke and by analyzing past trends in secondhand smoke exposure as determined by the 1999 to 2008 National Health and Nutrition Examination Surveys. Study results showed that the prevalence of secondhand smoke exposure among nonsmokers declined from 52.5% during the 1999-2000 survey to 40.1% during the 2007-2008 survey.

Despite this significant decrease in secondhand smoke exposure, this decline was only present for nonsmokers who did not live with a smoker in their home and also was not significant for non-Hispanic whites. This decline has also been shown to fluctuate from year to year and to be quite inconsistent. Furthermore, disparities among secondhand exposure still exists and study results have shown that exposure during every survey cycle is greater among men than among women; among non-Hispanic blacks than among non-Hispanic whites and Mexican-Americans; among children and youth than among adults; and among those below the federal poverty line than among those at or above the federal poverty line. What is most impressive, however, is that despite this decline in secondhand smoke exposure, 88 million nonsmokers who are above the age of three were still exposed to secondhand smoke during 2007-2008 and among these 88 million, 32 million were America’s children and youth (ages 3-19 years).

The results reported in this MMWR have major implications for public health practice and policies. Partnership for Prevention advocates for increases in state, local, and voluntary smoke-free policies in order to make this decline in secondhand exposure consistent and to eliminate existing disparities, especially among youth and children. Currently only twenty-four states and the District of Columbia have comprehensive smoke-free laws covering workplaces, restaurants, and bars. Complete state-wide bans are needed in order to reduce secondhand smoke exposure and protect the American public.

Homes were also shown to be a major source of secondhand smoke exposure, especially for children. Following the American Academy of Pediatrics and the U.S. Public Health Service’s recommendation, Partnership for Prevention supports efforts to increase clinician interventions for those parents who smoke. It is recommended that these parents not only get help in quitting smoking, but are also educated about the harms of secondhand smoke.

The Healthy People 2010 goal of reducing secondhand smoke exposure among the nonsmoking population to less than 56% has been accomplished. However, there are still a vast number of Americans who are exposed to the potential dangers of secondhand smoke. With more smoke-free policies and a greater emphasis on preventing at-home exposure, we can do a better job of safeguarding America’s nonsmokers.


Katie Burggraf
Tobacco Control Team
Partnership for Prevention

The new Medicare benefit that provides coverage for tobacco cessation counseling to all smokers was named the “Best News for Prevention” while the stalling of youth smoking rates in recent years was named the “Worst News for Prevention.”

BEST

Expanding Coverage: Medicare Offers New Tobacco Cessation Counseling Benefit

On August 25th, the U.S. Department of Health and Human Services announced an expansion of Medicare coverage that is supported by many tobacco control advocates around the nation. This new expansion offers coverage of evidence-based tobacco cessation counseling, allowing many more smokers to get the treatment that they need.

Despite the fact that Medicare provides coverage for over 43 million beneficiaries, tobacco counseling was previously only offered to those individuals who were diagnosed with or showed symptoms of a tobacco-related disease. This new benefit provides coverage for tobacco cessation counseling to all smokers. As Secretary Kathleen Sebelius explains, “For too long, many tobacco users with Medicare coverage were denied access to evidence-based tobacco cessation counseling. Most Medicare beneficiaries want to quit their tobacco use. Now, older adults and other Medicare beneficiaries can get the help they need to successfully overcome tobacco dependence."

WORST

Youth Smoking Rates Now Stalled


Although teen smoking rates dropped in the past decade, they have stalled in recent years, which means increased tobacco prevention efforts are needed, a new U.S. government study shows.

Between 2000 and 2009, cigarette smoking rates declined from 28 percent to 17.2 percent among high school students, and from 11 percent to 5.2 percent among middle school students, said researchers from the Centers for Disease Control and Prevention.

However, they noted that the declines between 2006 and 2009 were not statistically significant -- from 19.8 percent to 17.2 percent among high school students and from 6.3 percent to 5.2 percent among middle school students.


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/.