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Cessation
Subcommittee
Hubert Humphrey Building
200 Independence Avenue, SW
Room 705
Washington, DC
January
16, 2003
8:30 a.m. – 2:30 p.m.
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
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.
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
[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.
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.
Revised Recommendation: Launch an ongoing, extensive paid media campaign by 2004 to help Americans quit using tobacco.
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.
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.
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.
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.
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.
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.
Two people offered comments.
William Corrigal, National Institute on Drug Abuse
Matthew Barry, Campaign for Tobacco-Free Kids
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.
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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