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Regional Meeting
Public Meeting on
Promoting Smoking Cessation Efforts
December 3, 2002
8:30 am to 4:00 pm
Hyatt Regency O’Hare, Rosemont, IL
Discussion Topics
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 the meeting by reviewing the purpose and objectives of the
Cessation Subcommittee of the Interagency Committee on Smoking and Health (ICSH).
In August 2002, the ICSH established a separate working subcommittee to focus
national attention on cessation. This subcommittee is an advisory group to the
ICSH and is charged with developing a set of proposed action steps that will be
presented to HHS Secretary Tommy Thompson in the winter of 2003. These
recommendations will serve as the basis for a Secretary’s initiative on
cessation, beginning in 2003, that will involve a series of federal initiatives
and public-private partnerships designed to reduce tobacco prevalence in the
United States by promoting evidence-based cessation.
The action plan will be informed by four evidence-based documents:
- Public Health Service’s Clinical Practice Guideline: Treating Tobacco
Use and Dependence
- U.S. Task Force on Community Preventive Services’ Guide to Community
Preventive Services: Tobacco Use Prevention and Control
- Action Plan on Tobacco Use Cessation: Recommendations from the
Interagency Committee on Smoking and Health (after the August 14, 2001
meeting entitled “Smoking Cessation: Facing the Challenges of Tobacco
Addiction.”)
- National Blueprint for Disseminating and Implementing Evidence-Based
Clinical and Community Strategies to Promote Tobacco Use Cessation
The action plan will also be informed by the oral and written public
testimony presented to the subcommittee during three regional meetings and up
until December 20, 2002. During this period of public comment, the subcommittee
hopes to hear from smokers and their families, clinicians, health care
administrators, researchers, purchasers, insurers, and others regarding
opportunities to promote cessation, barriers to action in promoting cessation,
and recommendations for overcoming these barriers.
HHS Secretary Tommy Thompson has challenged the subcommittee to present him
with a bold and innovative plan that will substantially decrease tobacco use
rates in the United States by promoting smoking cessation.
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The subcommittee’s task is specific and time limited. The group will meet
only five times: the first introductory meeting was held on October 1st, the
first regional hearing on October 24th in Washington, D.C.; the second regional
hearing on November 14th in Westminster, Colorado; and the third and final
hearing today in Rosemont/Chicago, Illinois. The committee will meet a fifth and
final time in January, 2003 to finalize the action plan before presenting it to
Secretary Thompson in early 2003.
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Testimony can be submitted both orally and written, and those presenting oral
testimony are encouraged to follow-up with written comments which will be
accepted until December 20, 2002. It was emphasized that the focus of the
subcommittee is on cessation and testimony should reflect this focus.
Each individual testifying during any of the three regional hearings is given
a limit of three minutes for remarks, with two minutes following the testimony
for subcommittee members to ask clarifying questions if necessary.
During this morning’s session, three invited presentations by Drs. Frank
Chaloupka, Matthew Farrelly, and Susan Zbikowski were added to provide
background for the subcommittee.
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Challenge and Promise of the Initiative
Dr. Fiore ended his introductory remarks by reminding the subcommittee
and meeting participants of the challenge and promise presented by this
effort. While we have a strong body of evidence supporting effective
interventions to help smokers quit, and the majority of tobacco users want
to quit, there is widespread reluctance among clinicians, health care
systems and the federal government to put what we know is effective into
practice. The charge of the subcommittee is to change this situation by
ensuring that clinical and population-based strategies are implemented --
thereby reducing tobacco use and improving lives for millions of Americans.
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Sharon Carothers (for Cheryl Healton)
American Legacy Foundation
Susan Curry, PhD
Health Research and Policy Centers, University of Illinois at Chicago
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
Rosemarie Henson, MSSW, MPH
Office on Smoking and Health, CDC
Howard Koh, MD, MPH, FACP
Commonwealth of Massachusetts
Scott Leischow, PhD (for Robert Croyle)
National Cancer Institute
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
Capt. Larry N. Williams, DC, USN
Dental Department, Military Medical Support Office, US Navy
Members unable to attend on December 3rd:
Robert Croyle, PhD
National Cancer Institute
Charles Cutler, MD, MS
American Association of Health Plans
Christine Williams
Agency for Healthcare Research and Quality
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Fifty-two individuals presented testimony during the meeting. A summary
of the recommendations follows, and it should be noted that these
recommendations are paraphrased and are not presented in any specific order.
- There is a need for regulatory flexibility in fast track research and
approval for new tobacco dependence treatments. (Mermelstein/Van Brunt)
- The United States would benefit from effective regulation of tobacco
products by the Food and Drug Administration. (Mermelstein)
- Although the focus of this subcommittee is on cessation, it is crucial
to not lose sight of a comprehensive approach to tobacco control. The
Department should continue to support the establishment, implementation
and continuation of such comprehensive state-based programs. (Mermelstein/Van
Brunt/Houston)
- HHS must support a sustainable, dedicated and non-vulnerable funding
stream to support tobacco cessation. (Zbikowski/J. Williams) Without
dedicated funding, most of the recommendations presented to the
subcommittee cannot be implemented. (Gundersen)
- The most effective strategy for reducing prevalence is to work
simultaneously on youth prevention and adult cessation efforts. (J.
Williams/Benuck)
- Effective public/private partnerships exist for addressing tobacco
use, and should be considered as models for future activities. Examples
are the ASSIST program (Grande), the Minnesota quit line (Willoughby), and
Wisconsin’s First Breath Program (Jehn).
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- Coverage of effective tobacco dependence treatment in all federally
funded health care programs should be required as a regular part of
medical care. (Morse/Mangskau/Zbikowski) Pregnant smokers should receive
interventions specifically tailored to their needs and insurance coverage
should continue into the postpartum period. (Jehn)
- Medicare and Medicaid coverage for a comprehensive tobacco use
treatment benefit, including drug coverage and consistent with the PHS
Clinical Practice Guidelines, should be available to all tobacco using
beneficiaries. (Mangskau/Houston/Zbikowski/Sims/Grande)
- A portion of Medicaid funding in every state should be specifically
allocated for tobacco control activities based on the CDC’s Best
Practices’ estimates for that state. (Gundersen)
- HHS should encourage private medical and dental insurers to provide
coverage for tobacco dependence treatment, including pharmacotherapy,
counseling, and extra assistance. (Morse/Zbikowski/Hasiakos)
- There should be greater recognition of individuals who have
successfully quit using tobacco and HHS should launch a “cessation
celebration” initiative to honor these individuals. (Morse/Hyng)
- Cessation services should be more widely available in schools and on
college campuses. (Park/Black/Alzati)
- Tobacco users should be educated about the availability and importance
of evidence-based treatments. (Tornow) Myths and misunderstandings about
NRT – particularly in the African-American population -- should also be
addressed. (Sutton)
- Additional funding is necessary to develop programs to reach specific
populations such as pregnant women. (Mangskau)
- To reach Latinos, cessation programs must be delivered by
bilingual/culturally competent staff. (Dwarka)
- HHS should encourage pharmaceutical companies to make pharmacotherapy
available at a reasonable cost to consumers. (Marks)
- Uninsured or underinsured tobacco users should have barrier-free (low
cost or no cost) access to cessation services, including medicine.
(Grande)
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- The “5 A’s” for treating tobacco dependence must be institutionalized
into all visits with health care professionals. (Mangskau)
A national system to train and credential specialists in the treatment of
tobacco dependence should be developed. (Ringen/Schmitz/Hasiakos/Houston/Grande)
- There is a need for greater awareness among providers about the PHS
Clinical Practice Guidelines. (Bundy)
- A core curriculum for tobacco intervention should be developed and
integrated into medical, dental and allied health professional training,
including effective interventions for reaching pregnant smokers.
(Albrecht/Hasiakos/Marks)
- Health professionals who work with children should be trained in
strategies and methods for reaching parents who smoke to help them better
understand the negative impact their smoking has on their children. (Benuck)
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- There is a need to expand population-based approaches to tobacco
control including increasing the number of clean indoor air ordinances
across the country. (Houston/Grande)
- Health objectives specifically targeting blue collar workers should be
re-established to reach Healthy People 2010 tobacco related goals. (Ringen)
- The federal excise tax on cigarettes and other tobacco products should
be increased substantially. (Mangskau/Houston/Chaloupka/Grande) It is
essential that a significant portion of the tax increase be dedicated to
state level tobacco control efforts and a substantial amount of these
funds dedicated to tobacco use treatment. (Ahrens/Zbikowski/Chaloupka)
- HHS should undertake an initiative to translate smoking cessation
materials into multiple languages, making them culturally relevant and
available electronically. (Brown)
- To reach traditionally underserved populations, cessation efforts must
be institutionalized at the community and grassroots levels, and the faith
community can be a strong partner in these efforts. (Langford)
- All United States residents should have barrier-free access to
telephone quit lines. (Zbikowski/Carothers/Grande) Public-private
partnerships between health departments and health plans in operating such
quit lines – similar to the Minnesota model – should be replicated.
(Willoughby/Carothers) A paid media campaign promoting this service is
important to motivate utilization and multi-lingual services are crucial
to engaging non-English speakers. (Willoughby/Carothers/Zang)
- A standardized protocol for quit lines should be developed. Carothers/Marks)
- HHS should ensure that Latinos and African-Americans participate in
decision-making about programs and interventions that are intended for
these populations. (Dwarka/Bundy)
- The federal government should initiate and sustain a national,
evidence-based media campaign focused on cessation. (J. Williams)
- Work-place focused cessation efforts should be increased. (Seidler)
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- Private insurers have a fiduciary responsibility to cover tobacco use
treatment for blue collar workers. (Ringen)
- Leaders of group health plans should be convened to “hear the case”
about the importance of covering tobacco use treatment services for blue
collar workers. (Ringen) Health plans need to have a better understanding
of the return on their investment in smoking cessation efforts.(McConnell)
- HHS should provide funding for clinics making systems changes in the
way that tobacco users are identified and treated. (Brown)
- Health plans offering nicotine replacement therapy should reduce
barriers by eliminating co-payment and prescription-only requirements.
(Willoughby)
- A standardized system to identify tobacco users should be developed. (Lingeman)
- Provider reminder systems that prompt clinicians to ask about tobacco
use status, and/or adding tobacco use status as a vital sign, should be
incorporated into all encounters with patients. (Sims/Bundy)
- Performance measures should be used and integrated into public
oversight and accountability systems. (S. Williams). Smoking cessation
should be included as a core performance measure for states (Mangskau)
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The federal government should encourage and fund research in the
following areas:
- Neurobiology of the causes and consequences of nicotine addiction (Corrigal)
- More effective tobacco treatments tailored to specific populations,
including racial and ethnic minority populations, older Americans,
adolescents, gay, lesbian, bisexual and transgender tobacco users and blue
collar workers. (Brown/Sutton/Gooden/Schillo/Sims/Hamilton/Maloney/Bundy/
Kelder)
- Long-term relapse prevention (Sutton/Maloney)
- More specific surveillance systems that break down prevalence data into
subgroup-specific information (ex. Asian Americans/labor and service workers).
(Kim/Kelder)'
Following the public testimony, Michael Schooley, Executive Secretary for the
Interagency Committee on Smoking and Health, thanked all those who provided
testimony, and encouraged everyone to supplement oral testimony with written
remarks. Written testimony can be submitted through December 20th, 2002, by
accessing the www.cdc.gov/tobacco Web
site. Mr. Schooley added that the subcommittee would break for a one hour lunch
and then reconvene for an additional meeting to review what they had heard in
the morning. This afternoon meeting was open to the public.
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