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Interagency Committee on Smoking & Health


Final Meeting Summary

 On This Page

Welcome and Introductions
Goals and Schedule of the Meeting
Cessation Subcommittee members in attendance
Discussion of Recommendations
Public Comments
Discussion of Additional Recommendations
Conclusion and Next Steps

Cessation Subcommittee
Hubert Humphrey Building
200 Independence Avenue, SW
Room 705
Washington, DC

January 16, 2003
8:30 a.m. – 2:30 p.m.

 

Welcome and Introductions

Michael Fiore, M.D., M.P.H., Professor, Department of Medicine, Director, Center for Tobacco Research and Intervention, University of Wisconsin Medical School, Madison, Wisconsin

Chair, ICSH Cessation Subcommittee

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Goals and Schedule of the Meeting

Dr. Fiore began by informing the committee that he had met with Secretary Thompson the previous day and asked Dr. Fiore to thank committee members on his behalf for their time and commitment to the effort.  Secretary Thompson sent his regrets that he could not join the meeting because of out-of -state travel.

The purpose of the day’s meeting was to finalize the recommendations and determine (a) whether the evidence base clearly supported each recommendation and (b) whether a strong enough case was being made in support of each recommendation.

Dr. Fiore reviewed the following features of the Action Plan:

  • Meaningful reductions in both tobacco use and the resultant burden of illness, premature death, and economic costs

  • Science-based

  • Address disparities

  • National in scope; regional in application

  • Public-private partnerships

  • Impact should be both immediate and sustained

  • Comprehensive and integrated

  • Securely funded

During the course of the day’s meeting, Dr. Fiore asked that each recommendation be discussed for approximately 20 minutes.  Following these discussions, there would be an opportunity to identify possible new recommendations as well as an opportunity for the public to provide comments.

Following the meeting, staff would incorporate subcommittee comments, gather evidence supporting each of the recommendations, compile a complete bibliography, create an Executive Summary and present the final draft to the full Interagency Committee on Smoking and Health sometime during the first two weeks of February, 2003.  Following this time frame, the report will be submitted to the Secretary by the end of February.

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Cessation Subcommittee members in attendance on January 16 include the following

Robert Croyle, PhD
National Cancer Institute

Susan Curry, PhD
Health Research and Policy Centers, University of Illinois at Chicago

Charles Cutler, MD, MS
American Association of Health Plans

Ronald Davis, MD
Center for Health Promotion and Disease Prevention
Henry Ford Health System

Michael Fiore, MD, MPH
Center for Tobacco Research and Intervention, University of Wisconsin Medical School

Catherine Gordon, RN, MBA
Office of Clinical Standards and Quality, Center for Medicare and Medicaid Services

Cheryl Healton, DrPH
American Legacy Foundation

Rosemarie Henson, MSSW, MPH
Office on Smoking and Health, CDC

James Marks, MD, MPH
National Center for Chronic Disease Prevention and Health Promotion, CDC

C. Tracy Orleans, PhD
The Robert Wood Johnson Foundation

Dennis Richling, MD
Health Services, Union Pacific Railroad

David Satcher, MD, PhD
National Center for Primary Care, Morehouse School of Medicine

Michael Schooley, MPH
Office on Smoking and Health, CDC

John Seffrin, MD
American Cancer Society

Christine Williams
Agency for Healthcare Research and Quality

Capt. Larry N. Williams, DC, USN
Dental Department, Military Medical Support Office, US Navy

 

Members unable to attend on January 16th include the following
Howard Koh, MD, MPH, FACP
Commonwealth of Massachusetts

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Discussion of Recommendations

[The following represents a general overview of issues discussed relating to each of the recommendations.  A full transcript is available on request please contact Jessica Porras for a copy.


Recommendation: The Subcommittee recommends that a state-managed National Quitline be established by 2004 that will provide both counseling and medications to any smoker who is motivated to quit.

  • Change the term smoker to tobacco user throughout the Action Plan.
  • Address the issue of states that are not able to manage their own quitline and may “outsource” to other states or regions.
  • Recommendation must include reference to “universal access.”
  • State match requirement.
  • Evidence supporting effectiveness of state vs. national quitline.

Revised Recommendation: The Subcommittee recommends that a federally-funded National Quitline be established by 2004 that will provide universal access to evidence-based counseling and medications for all tobacco users.  This quitline would provide a national portal to state or regionally managed quitlines.


Recommendation: The Subcommittee recommends that an extensive media campaign be undertaken by 2004 to help Americans quit smoking.

  • Strengthen wording of recommendation.
  • Add the word “paid” to media campaign.
  • Change “smoking” to “using tobacco”.
  • Assure that the campaign will be ongoing and supported by the federal government.

Revised Recommendation:  Launch an ongoing, extensive paid media campaign by 2004 to help Americans quit using tobacco.


Recommendation: The Subcommittee recommends that by 2004, health insurance coverage for all federally covered lives include evidence-based counseling and pharmacotherapy for smoking cessation.  This includes federal employees, Department of Defense personnel, Veterans Administration covered veterans, Medicare recipients, Medicaid recipients and individuals receiving health care from federally funded clinics.

  • The term “insurance” should be replaced with “health coverage.”
  • Distinction between “beneficiaries”  and “federally supported beneficiaries.”
  • Discussion about the need to graphically demonstrate how all of these recommendations tie together.
  • Important that these services are available at no cost to the tobacco user.
  • Discussion about the necessity of educating providers about the benefit.

Revised Recommendation: By 2004, benefits for all federal employees and in all federally-funded health care programs include evidence-based counseling and pharmacotherapy for tobacco use cessation.


Recommendation: The Subcommittee recommends that by 2004, a substantial new investment be made in tobacco dependence research and training to increase substantively tobacco dependence treatment effectiveness  and to ensure that all new clinicians trained in the United States have the skills necessary to help their patients successfully quit tobacco use.

  • This should be split into two separate recommendations: one for research and one for training.
  • The research recommendation should be explicit about the need for a broad and balanced research agenda – from basic through applied.
  • The training recommendation should include “training and education.”
  • Discussion about whether the training recommendation should refer to “clinicians” or “all healthcare providers.”  Decision to focus recommendation on clinicians but address the issue of training for other healthcare providers in supporting text.
  • Discussion about limited evidence base supporting the effectiveness of training.
  • Systems must also change to support clinician behavior and should be addressed in body of recommendation.

New Recommendation: The Subcommittee recommends that by 2005, a substantial new investment be made in a broad and balanced research agenda (basic, clinical, public health, dissemination) to continually improve the reach, effectiveness and adoption of tobacco dependence treatment and cessation interventions at the individual and population levels

New Recommendation: The Subcommittee recommends that by 2004, a substantial new investment be made in training and education to ensure that all clinicians in the United States have the knowledge, skills, and support systems necessary to help their patients successfully quit tobacco use.


Recommendation: The Subcommittee recommends that by 2004, a Smokers’ Health Fund be established by increasing the Federal Excise Tax on cigarettes by $2.00 per pack (from the current rate of $0.39 to $2.39) with a similar increase in the excise tax on other tobacco products.  At least 50% of the new revenue generated by this tax increase (at least $14 billion of the estimated $28 billion generated) should be secured and earmarked to pay for the components of this action plan.

  • Remove term “secured” and replace with “earmarked.”
  • Discussion about the appropriate way to frame this recommendation (e.g. asking smokers to pay through the increased tax on tobacco products) for help in quitting which 70% say they want to do.
  • Supporting text must address regressivity arguments and how higher revenues from a tax increase could be allotted to lower income groups.
  • Discussion about the name of the fund – decision to keep the term smoker (as opposed to tobacco user).
  • Supporting text must illustrate the broad public support, as indicated through polling data, for a higher tax on tobacco products.
  • Supporting text must also address states’ concerns regarding loss of revenue and overall impact resulting from this tax increase.

Revised Recommendation: The Subcommittee recommends that by 2004, a Smokers’ Health Fund be established by increasing the Federal Excise Tax on cigarettes by $2.00 per pack (from the current rate of $0.39 to $2.39) with a similar increase in the excise tax on other tobacco products. At least 50% of the new revenue generated by this tax increase (at least $14 billion of the estimated $28 billion generated) should be earmarked to pay for the components of this action plan.


Recommendation:  The Subcommittee recommends that the Secretary call for all health insurers to provide coverage for tobacco use cessation as part of the basic benefits package offered to all individuals and groups seeking insurance coverage.  Coverage should include both counseling and all FDA-approved medications for treating tobacco dependence as described in the U.S. Public Health Service Clinical Practice Guideline Treating Tobacco Use and Dependence.  Coverage should be barrier-free to encourage use, and widely advertised to ensure that beneficiaries and clinicians are aware of this covered benefit.

  • Add employers and purchasers to this recommendation.
  • A strong business case must be made to encourage employers (who are cutting back on benefits, not adding to them) to include tobacco dependence treatment benefits.
  • Again, discussion about the need to graphically demonstrate how all of these recommendations tie together.

Revised Recommendation: That the Secretary challenge and engage with all insurers, employers, and purchasers that pay for or provide health coverage to include barrier-free coverage for evidence-based tobacco dependence treatment (counseling and pharmacotherapy) as part of the basic benefits package offered to all individuals and groups seeking insurance coverage.


Recommendation:  The Subcommittee recommends that the Secretary strongly advocate for systems-level changes that promote the effective implementation and utilization of cessation treatments.

  • Important to include reference to systems change to improve the quality of care.
  • Subcommittee members agreed to work on language related to this recommendation and get it to the chairperson.

Revised Recommendation: That the Secretary advocate for systems-level changes and quality improvement strategies to expand the delivery of evidence-based tobacco dependence treatments and engage decision makers in the public and private sectors to achieve those aims.


Recommendation:  The Subcommittee recommends that the Secretary and DHHS work in partnership with national quality assurance and accreditation organizations, health care systems, managed care organizations, and providers to ensure that provision of comprehensive, evidence-based tobacco cessation services is established as a standard of care and provision of such services is routinely measured in all health care delivery settings.

  • Discussion about the issue of “accountability” and its importance at all levels of healthcare delivery.

Revised Recommendation: That the Secretary work in partnership with national quality assurance and accreditation organizations and other health care stakeholders to ensure that provision of evidence-based tobacco dependence treatment is established as a standard of care and is routinely measured uniformly in all health care delivery settings.

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Public Comments

Two people offered comments. 

William Corrigal, National Institute on Drug Abuse

  • Important to articulate the spectrum of research needs including basic, clinical, population and translational.
  • Stressed the importance of public-private partnership on the research agenda — particularly in the area of new medication development.

Matthew Barry, Campaign for Tobacco-Free Kids

  • Importance of providing extensive evidence supporting the effectiveness of tax increases.
  • Need to clearly illustrate the effect of a federal tax increase on state revenues.

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Discussion of Additional Recommendations

One suggested recommendation was briefly discussed by the Subcommittee and it was agreed that, although important, it was too broad in scope for the purpose of this Subcommittee’s work.

A second new recommendation was suggested which focused on addressing the important role of community-based activities in tobacco cessation efforts.  The Subcommittee agreed on its inclusion, began to work on the wording.

New Recommendation: That the Secretary initiate and support partnerships among community-based organizations (e.g. schools, churches, employers, voluntary organizations) and health care organizations to put in place programs and policies that enhance tobacco users’ motivation and support to quit and increase their access to evidence-based care.

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Conclusion and Next Steps

Dr. Fiore thanked Subcommittee members for their hard work and reviewed the timeframe for comments and follow-up suggestions.

The meeting adjourned at 2:30 p.m.

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This page last reviewed April 24, 2003

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