Prevention Matters

On June 22, 2010 new restrictions on tobacco product sales and marketing under the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act) finally went into effect. This act is specifically aimed at protecting children and youth from the dangers of using tobacco. These restrictions prohibit the sale of cigarettes and smokeless tobacco to people under the age of eighteen; prohibit the sale of cigarette packs with less than twenty cigarettes; prohibit the distribution of free samples of cigarettes and smokeless tobacco; and prohibit tobacco companies from sponsoring many events such as music concerts, athletic games, and other cultural or social gatherings. These are certainly great strides for tobacco control, but the U.S. Food and Drug Administration (FDA) and tobacco prevention advocates still have a ways to go in order to continue to prevent tobacco use among America’s youth.

One major task is educating both retailers and the public about these new restrictions. The FDA has wasted no time and is tackling this issue with their new website: Break the Chain of Tobacco Addiction. The website features various ways for retailers, organizations, and the general public to “spread the word” about the new regulations. The site has flyers and posters available for download with slogans such as “Don’t Let Minors Buy Tobacco. It’s the Law. Break the chain of tobacco addiction. Keep tobacco out of the hands of America’s youth. It’s the right thing to do” and “Break the Chain of Tobacco Addiction: I follow the law. I don’t sell tobacco to minors.”

The FDA is also using their website to help people “Stay Informed” – visitors to the website can sign up for e-mail updates, an RSS feed, or become a follower on Twitter. There are also various links to information and materials to help people “Learn More” and there are a variety of “Guidances” for the help the tobacco industry comply with these new regulations. The FDA is encouraging organizations to feature its widget that scrolls content from the FDA’s website and the “Break the Chain” badge on their own sites.

To help spread the word about these important new regulations, visit the “Break the Chain” website at http://www.fda.gov/TobaccoProducts/ResourcesforYou/BreakTheChain/default.htm.


Katie Burggraf
Tobacco Control Team
Partnership for Prevention

A recent USA Today/Gallup poll found that opinions on smoking in public places are drastically changing and not to the benefit of tobacco users. Since Gallup’s first poll in 1987 on restricting smoking in public places, respondents have become increasingly opposed to smoking in restaurants, hotels, and in workplaces. The percentage of those in support of banning smoking in restaurants and hotels has more than tripled since the first Gallop poll, and has more than doubled for the percentage of those in favor of workplace smoking bans.

The 2010 Gallup poll found that 59 percent of respondents believed that smoking should be banned in restaurants, an increase when compared to the 54 percent who wanted smoking restrictions in restaurants during the 2007 Gallup poll. Partnership for Prevention is pleased that smoking bans in public places are becoming more and more popular and the risks of secondhand smoke are also becoming increasingly evident. However, only 31 percent of poll respondents favored, in bars. In fact, 23 percent of respondents actually favored having no restrictions in bars and 43 percent believed that designated areas should be set aside for smokers in bars. In addition, while only 36 percent of participants felt that smokers should be accommodated in restaurants, the majority thought that smokers should be accommodated in workplaces and hotels/motels (52% and 58% respectively).

Why this change in opinion all of a sudden?

One possible reason is that the percentage of current cigarette smokers has declined from 30 percent in 1987 to the current prevalence of 22 percent. Gallup polls have consistently shown that nonsmokers are more likely to support smoking bans compared to smokers. Thus, this decline in smoking trends could offer some explanation as to why public smoking is being favored less and less.

Another possible reason is that the public is becoming increasingly aware of the dangers of secondhand smoke, especially after the US Surgeon General’s 2006 report, The Health Consequences of Involuntary Exposure to Tobacco Smoke. The percentage of people who perceive that exposure to secondhand smoke poses a serious threat to a nonsmoker’s health has also increased dramatically from 36 percent in 1994 to 55 percent in 2010.

These poll results suggest that we may be going further than the majority of Americans would prefer with some restrictions on public smoking, but more importantly that we may not be going far enough with other restrictions. Currently only half of all states in the U.S. have broad smoking bans that restrict smoking in public places.

The question remains however: How far should we go?

Certainly we need to protect nonsmokers from the dangers of secondhand smoke, but at what point do we have to stop ignoring public opinion? Perhaps the problem is not simply overriding the public’s opinion on smoking bans, but rather working towards educating the public and helping to change the public’s opinion on smoking restrictions in public places.

For more information please visit: http://www.gallup.com/poll/141809/americans-smoking-off-menu-restaurants.aspx


Katie Burggraf
Tobacco Control Team
Partnership for Prevention

The good news is that 30 million women who are currently uninsured or underinsured will benefit from the recently passed Affordable Care Act (ACA). These women and their children will enjoy a full range of comprehensive benefits through private insurance, or the Medicare and Medicaid programs. A recently released study by the Commonwealth Fund, “Realizing Health Reform’s Potential: Women and the Affordable Care Act of 2010,” examined the ACA’s provisions to identify their impact on access to health services, as well as future cost implications. Provisions eliminating the pre-existing condition exclusion, requiring coverage for maternity and newborn care, providing insurance purchase subsidies, limiting out-of-pocket expenses and prohibiting higher premiums based on gender, all contribute to a significantly more positive future for women seeking health care.

The report also highlights the new preventive care benefits that will provide increased access to high value recommended services from the U.S. Preventative Services Task Force (USPSTF) without cost-sharing. However, the report missed the mark by failing to mention tobacco cessation. Tobacco-related disease is the leading cause of death in the U.S. causing over 170,000 deaths per year among women. In 2006, 18 percent of adults with private health insurance were current smokers, compared to 35 percent of Medicaid recipients and 34 percent of the uninsured population. All USPSTF recommendations are linked to a letter grade that reflects the level of certainty of the evidence supporting the preventive service. The ACA will make access to the “A” ranked smoking cessation treatments a reality for more women. And, their children will benefit from reduced exposure to secondhand smoke, thereby decreasing incidence of asthma and other related conditions. Under the federal Medicaid program, tobacco cessation services are a mandated benefit for pregnant women. A good start, but all Medicaid enrollees should have access to smoking cessation counseling and medications.

Preventive services not only help keep people healthy, they also save lives. 42,000 lives can be saved each year by helping more smokers quit.

Read the full report - Realizing Health Reform's Potential: Women and the Affordable Care Act of 2010.


Diane Canova
Vice President, Policy & Programs
Partnership for Prevention

Cigarette smoking causes 443,000 deaths annually and is the predominant form of tobacco used in the United States. However, adults also use other tobacco products either singly or in combination. The need to address this issue in tobacco use led the Centers for Disease Control and Prevention to analyze data from the 2008 Behavioral Risk Factor Surveillance System (BRFSS), which is a state-based telephone survey of non-institutionalized adults who are eighteen years or older, and publish a report in today’s Morbidity and Mortality Weekly Report (MMWR), “Any Tobacco Use in 13 States – Behavioral Risk Factor Surveillance System.”

The CDC analyzed data on the use of tobacco products other than cigarettes that had been collected from thirteen states who agreed to an optional BRFSS module. The CDC looked at data for current cigarette use, any tobacco use (tobacco users who currently used cigarettes, smokeless tobacco, or other tobacco products), and current polytobacco users (tobacco users who currently used cigarettes and also another form of tobacco). These three different variables were also analyzed according to various risk factors such as gender, household income, education, age, ethnicity, etc.

Researchers found that simply focusing on cigarette use may not be the best solution when it comes to tobacco control. According to the study, in 2008 cigarette use ranged from 14.6% to 26.6%, any tobacco use ranged from 18.4% to 35.0%, and polytobacco use ranged from 1.0% to 3.7% among the thirteen states. Use of any tobacco product was more prevalent among persons who were a member of an unmarried couple, (36.3%), single adults (30.3%), and those who were widowed or divorced (29.1%) compared to married persons (21.2%). Polytobacco use was found to be more prevalent among men (4.4%), young adults between the ages of eighteen and twenty-four (5.7%), those who were single (4.8%), those who had a household income of less than $35,000 a year, adults with less than a high school education (3.6%), and those adults with only a high school diploma or GED (3.6%).

Results from this study show that while tobacco control efforts have focused mainly on decreasing the prevalence of cigarette smoking, the use of other tobacco products also needs to be addressed if we are to improve the health of our nation. When we consider any tobacco use, an additional 5% of the adult population in these thirteen states is added to the prevalence rate for tobacco use. Using multiple tobacco products can also have adverse health effects, lead to higher nicotine addiction, and make the tobacco user unable to quit using tobacco. For these reasons, and the fact that youth have higher polytobacco use than adults, prevention and health policy efforts need to be targeted towards all forms of tobacco and not just cigarette use.

Partnership for Prevention, a long standing advocate for evidence-based tobacco cessation policies, believes that tobacco control should be at the top of our health agenda and should involve proven strategies such as public awareness efforts, youth tobacco use prevention, tobacco tax increases, and smoke free air policies that address all forms of tobacco use.


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.

Partnership for Prevention recently exhibited at the 2010 National Conference of State Legislators (NCSL) in Louisville, Kentucky. The conference was widely attended by legislators, legislative staffers, government officials, business representatives, union members, foundation representatives and others interested in public policy. Concurrent sessions focused on the economy, transportation, education, health care, human services, energy, environment and professional development for legislators and staff. Many state representatives and senators came to the Partnership exhibit booth to hear information about the organization and its policy and programmatic efforts. Save Lives and Money - Help People on Medicaid Quit Tobacco, a new resource from Partnership for Prevention /ActionToQuit and the American Lung Association, garnered the most attention from state legislators and other conference attendees. This resource underscored that Medicaid recipients smoke more than any other population segment and made the argument that, by covering all of them, individual states could save both lives and money. Only six states lead the way in providing the seven recommended medications and group and individual counseling for all Medicaid patients. Save Lives and Money can be downloaded on the ActionToQuit website’s “Resources” section at http://actiontoquit.org/resources/.

Partnership staff also engaged legislators and staffers through the distribution of hand sanitizer, especially Kentucky Senator Gerald A. Neal (D). Senator Neal was intrigued by Partnership’s hand sanitizer “give away” as a mechanism to promote good health and prevent disease. The Kentucky Senator was very interested in distributing hand sanitizer at a community health event that stressed the importance of the prevention. During the dialogue, Partnership identified various health agenda intersections and plans to follow up with his office to discuss community health prevention. In addition to the hand sanitizer, Partnership also distributed a CD of the organization’s top five publications to legislative staffers. Entitled “NCSL 2010”, the CD included the following publications: 2009 Annual Report, CDC Action Guide: Places for Physical Activity, CDC Action Guide: Social Support for Physical Activity, Healthy Workforce 2010 and Beyond, Investing In Health, and Smokefree Policies. Legislative staffers liked the idea of having the organization’s most popular publications on a compact disc. Many expressed that it would help streamline their efforts when needing to consult with a “prevention” authority.

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