Advancing Tobacco Cessation Policy

1. Advancing Tobacco Cessation Policy David Zauche Senior Program Officer Partnership for Prevention October 13, 2011

3. Congressional Prevention Caucus Members Aspirin Task Force Partnership for Prevention Leading By Example National Chlamydia Coalition Action To Quit National Commission on Prevention Priorities Health Professionals Roundtable

6. ActionToQuit ActionToQuit urges all sectors – health plans, employers, quitlines, health care systems, and policymakers – to work together to ensure that all tobacco users have access to comprehensive cessation treatments.

7. What Does ActionToQuit Do? • ActionToQuit Network • Daily Listserv • Quarterly Educational Webinars • Website - www.actiontoquit.org • Monthly Podcasts

9. ActionToQuit State Policy Program Colorado: Cessation Coverage/Treatment for Colorado’s Uninsured Nevada: Increasing Cessation Access for All Nevadans (I-CAAN) Florida: Tobacco Cessation Summit & Action Plan New England: New England Partnership for Smoking Cessation Policy New York: New York Access to Tobacco Use Treatment Strategic Planning Project Virginia: Virginia Partnership for Tobacco Use Cessation

10. ActionToQuit State Policy Program • Problem statement: • Comprehensive tobacco cessation treatments have been proven to work but policy and health system barriers exist that prevent many smokers from utilizing them. • Goal: • Develop alliances in states to build their capacity for policy and system change. • Long-term Outcome: • Increase coverage for and utilization of tobacco cessation services in states.

11. ActionToQuit State Policy Program • Requirements Each funded project must do three things: • Develop state tobacco cessation alliance • Hold a state summit meeting for leaders and advocates • Create a state action plan to advance cessation policy/services

12. The Tobacco Problem Around the World and in the USA

13. Tobacco Worldwide • An estimated 1.3 billion people are smokers worldwide • Around 5.4 million deaths in 2011 will be caused by tobacco. But tobacco is projected to kill 6.5 million people in 2015 and 8.3 million 2030. • Smokers die on average 15 years sooner than nonsmokers. • Tobacco use will kill 1 billion people in the 21st century if current smoking trends continue.

14. Smoking in the USA • In the United States, smoking accounts for about one in five deaths annually. • 42% of American adults smoked in 1965 – 19% today. • Of the 45 million Americans currently smoking , half of them will die prematurely from diseases like lung cancer and heart disease. • Approximately 70% of smokers have the desire to quit and 40% of smokers try to quit each year.

15. The High Cost of Smokers • American Lung Association - $301 billion (September 2010) • Increased hospital days per 1000 employees (800 vs. 381) • More health-related absenteeism (6.7 days/year vs. 4.4 days/year) • Lost productivity time—up to 4 weeks per year (8% of total work time, in addition to regular breaks)

16. Florida Fatalities Average fatalities per 10 years: • Shark attacks – 2 - 3 • Alligator attacks – 10 • Lightening strikes – 90 • Murders – 10,000 • Tobacco use – 300,000

17. September 2011 MMWR Report Nearly 1 in 5 adults smokes (45.3 million total) Smoking declined from 20.9% in 2005 to 19.3% in 2010

18. MMWR - Who is at risk?

19. Current Cigarette Smoking Prevalence Among Working Adults • CDC analyzed National Health Interview Survey (NHIS) data for 2004-2010 • Overall, age-adjusted cigarette smoking prevalence among working U.S. adults was 19.6% • Highest smoking prevalence: • Less than high school education (28.4%) • No health insurance (28.6%) • Living below the federal poverty level (27.7%) • Aged 18-24 years (23.8%)

20. Smoking by Industry and Occupation • Industries with highest smoking rates • Mining (30.0%) • Accommodation and Food Services (30.0%) • Construction (29.7%) • Occupations with highest smoking rates • Construction and Extraction (31.4%) • Food preparation and serving related (30.0%) • Transportation and material moving (28.7%)

21. Recommendations • Implement proven interventions in workplaces with higher smoking prevalences • Smoke-free workplace policies • Individual, group, and telephone-based counseling • Cessation medications • Tailored print or web-based education materials • Comprehensive insurance coverage for effective cessation treatments • Workplace interventions should be tailored to the interests, challenges, and needs of particular industry or occupation groups.

22. Expansion of Cessation Services An Increasing Trend

23. USPHS 2008 Update Providing tobacco dependence treatments (both medication and counseling) as a paid or covered benefit by health insurance plans has been shown to increase the proportion of smokers who use cessation treatment, attempt to quit, and successfully quit. Therefore, treatments shown to be effective in the Guideline should be included as covered services in public and private health benefit plans.

24. U.S. Public Health Service Guideline • Clinicians should screen all adults for tobacco use and assess willingness to quit • Individual, group, and telephone counseling are effective, and their effectiveness increases with treatment intensity • Counseling and medication are effective when used by themselves. However, the combination of counseling and medication is more effective than either alone • Tobacco dependence is a chronic disease often requiring repeated interventions and multiple quit attempts

25. Coverage Makes a Difference Source: USPHS, Treating Tobacco Use an Dependence, 2008

26. Tobacco Cessation Benefit • The CDC’s recommended guidelines for smoking cessation benefits include five key actions: • Comprehensive tobacco cessation benefits cost between $1.20 and $4.80 per person per year compared to $1,623 per smoker per year in excess medical expenditures alone (not including lost productivity)

27. National Commission on Prevention Priorities

28. Summary • Tobacco dependence is a chronic, relapsing, and often fatal disorder. • Economic costs are enormous. • Tobacco cessation treatments are effective and cost-effective.

29. Engaging Employers in Tobacco Control The workplace is a key sector in tobacco control and businesses can make a significant contribution to saving lives from tobacco-related illness. On June 8, 2011 Partnership for Prevention and Legacy sponsored an educational webinar for the ActionToQuit Network and other tobacco control leaders nationwide. The program featured two companies, Sprint and Caterpillar, which have made a corporate commitment to tobacco control. Additionally, Ellen Vargyas of Legacy discussed the current debate over tobacco use and hiring policy.

30. www.actiontoquit.org

31. Thank You! Partnership for Prevention appreciates all the efforts of leaders in Iowa to advance tobacco cessation policy!

32. Graphic Warning Labels In June 2011 the Food and Drug Administration issued a final a rule to modify the required warnings that appear on cigarette packages and in cigarette advertisements. These new required warnings will consist of nine textual warning statements accompanied by color graphics depicting the negative health consequences of smoking.