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Regional Meeting
Interagency Committee on Smoking and Health
Cessation Subcommittee
October 24, 2002
8:30 am to 2:15 pm
Hotel Monoco, Washington, DC
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 charge and purpose
of the Cessation Subcommittee of the Interagency Committee on Smoking and
Health. The charge is to take the existing evidence base on effective tobacco
cessation interventions, supplement it (if necessary) based on public input from
three regional meetings, and develop an action plan for the Secretary of Health
and Human Services. This action plan will serve as the basis for a Secretary’s
initiative on cessation beginning in 2003.
There are two primary goals for the initiative: to increase the
number of quit attempts among the U.S. population of smokers and to encourage
the use of evidence-based treatment that is widely available but under-utilized
by those trying to quit.
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 met five times: the first introductory meeting was held on
October 1 and the three regional hearings were October 24, 2002, in Washington, DC;
November 14, 2002, in Denver, Colorado; and December 3, 2002 in Chicago, Illinois. The
committee met a fifth and final time in January, 2003, to finalize the
action plan before presenting it to the Secretary of Health and Human Services.
The Action Plan was 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 was also informed by the oral and written
public testimony presented to the subcommittee.
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Testimony was submitted both orally and written, and those
presenting oral testimony were encouraged to follow-up with written comments
that were accepted through 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 the meetings was given a limit of three
minutes for his or her remarks, with two minutes following the testimony for
subcommittee members to ask clarifying questions.
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Robert Croyle, PhD
Division of Cancer Control and Population Sciences, NCI
Susan Curry, PhD
Health Research and Policy Center, University of Illinois at Chicago
Ronald Davis, MD
Center for Health Promotion and Disease Prevention
Henry Ford Health System
Catherine Gordon, RN, MBA
Office of Clinical Standards and Quality, Center for Medicare and Medicaid
Services
Cheryl Healton, DrPH
American Legacy Foundation
James Marks, MD, MPH
National Center for Chronic Disease Prevention and Health Promotion, CDC
Dennis Richling, MD
Health Services, Union Pacific Railroad
Michael Schooley, MPH
Office on Smoking and Health, CDC
John Seffrin, PhD
American Cancer Society
Christine Williams
Office of Health Care Information, Agency for Healthcare Research and
Quality
Capt. Larry N. Williams, DC, USN
Dental Department, Military Medical Support Office, US Navy
Cessation Subcommittee members unable to attend on October 24:
Charles Cutler, MD, MS
American Association of Health Plans
Rosemarie Henson, MSSW, MPH
Office on Smoking and Health, CDC
Howard Koh, MD, MPH, FACP
Commonwealth of Massachusetts
C. Tracy Orleans, PhD
The Robert Wood Johnson Foundation
David Satcher, MD, PhD
National Center for Primary Care, Morehouse School of Medicine
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Twenty-one 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.
- The Department must realize a vision for tobacco cessation and must
demonstrate leadership through the programs directly under its control.
- 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. (Kane/Wostrel)
- There is a need to expand population-based approaches to tobacco
control because the success of cessation efforts depends on other
elements such as media and community programs. (Stillman)
- The most effective strategy for reducing prevalence is to work
simultaneously on youth prevention and adult cessation efforts. (Henningfield)
- There is synergy derived from a multi-modal approach where smokers are
encouraged and supported to quit through policies, and interaction with
clinicians, health systems and their peers.(Rand/Stillman)
- To be successful, there must be sustainable, dedicated and
non-vulnerable funding to support state-based comprehensive tobacco
control programs. (Bailey)
- The United States would benefit from effective regulation of tobacco
products by the Food and Drug Administration to prohibit the tobacco
industry from introducing new products that encourage tobacco users to
switch rather than quit. (Corr)
- There is a need for regulatory flexibility in fast track research and
approval for new tobacco dependence treatments (Henningfield)
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- There should be required coverage of effective tobacco dependence
treatment in all federally funded health care programs as a regular part
of medical care. (Corr/Bailey)
- The Department can act as a catalyst to promote coverage of tobacco
use treatment in other federal health care programs beyond HHS authority
including (but not limited to): Federal Employees Health Benefits
Program; TRICARE program for Department of Defense employees and
dependents; and individuals receiving services through the Department of
Veterans Affairs. (Corr)
- To reach traditionally underserved populations, cessation efforts must
be institutionalized at the community and grassroots level and materials
must be culturally appropriate. (Chandler)
- Medicare and state Medicaid websites should be used to publicly report
on provider performance. (Roski)
- Consumers should be educated about the availability and importance of
evidence-based treatments. (Roski)
- There is a need for wide-spread availability of teen specific
cessation programs in schools and communities. (Hoffman)
- A national panel should be created to review routine assessments for
prenatal exams and identify more accurate means for assessing pregnant
smokers. (Windsor)
- Evidence-based profiles of tobacco users who would benefit from
intensive approaches should be developed. (Gruman)
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- All clinicians employed in federally owned, operated, or funded health
clinics should be required to utilize the five As for treating
tobacco dependence. (Bailey)
- Cessation training should be mandated for allied health professionals.
(Polk)
- There is a need for more effective and sustained education of
providers regarding the benefits of tobacco cessation. (Corr)
- A national system to train and certify specialists and/or programs in
the treatment of tobacco dependence should be developed. (Barry)
- Cessation specific questions should be integrated into medical exams.
(Blumberg)
- Clinical practice guidelines for treating heavily addicted tobacco
users should be developed and these guidelines should be integrated into
mandated continuing education programs. (Gruman)
- Uninsured or underinsured tobacco users should have barrier-free (low
cost or no cost) access to intensive cessation services, including
nicotine replacement therapy. (Gruman)
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- All tobacco users should have barrier-free access to state-based
telephone quit lines and a paid media campaign promoting their use is
essential to motivate utilization. (Geiger/ Redmond/Kazimir)
- Teen cessation-targeted mass media campaigns should be developed which
include adolescent specific telephone quit lines and Internet
strategies. (Hoffman)
- Systems should be established to identify and support pregnant
smokers. (Windsor/Gaffney)
- The Federal government should fund a national, evidence-based public
education campaign (not PSAs) targeted at tobacco users to educate them
on the harms of tobacco use, proven means of helping them quit, and how
to access cessation services. (Bailey/Corr)
- The federal excise tax should be increased which would lead to an
increase in cessation and would provide a potential dedicated funding
stream for cessation treatments and activities. (Bailey/Corr)
- Toll free telephone numbers and website addresses should be printed on
every tobacco product package including a viable means of financial
coverage for treatment options. (Henningfield)
- Efforts to promote clean indoor air laws and policies should be
strongly supported. (Corr)
- The influence of the "unsung heroes" in communities,
churches, and neighborhoods should be capitalized upon to educate peers
about tobacco use and effective treatments. (Chandler)
- Federal matching money should be provided to states to encourage them
to fund cessation programs. (Wostrel)
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- Medicare and Medicaid coverage for a comprehensive tobacco use
treatment benefit consistent with the PHS Clinical Practice Guidelines
should be available to all tobacco using beneficiaries. (Corr)
- Incentives should be provided to states to encourage Medicaid coverage
of cessation products and counseling.
- Private insurers should be required to provide coverage for tobacco
dependence treatment in all health care programs including medical,
dental, mental health and substance abuse care. (Henningfield)
- State and local public employers should be required to cover tobacco
use treatment for their employees. (Wostrel)
- The Department should work with private sector partners such as the
National Committee on Quality Assurance (NCQA) to support the
development of evidence-based performance measures at all levels of the
health system, particularly at the provider level. (Roski)
- Performance measures should be used and integrated into public
oversight and accountability systems such as a "condition of
participation" for Medicare providers. (Roski)
- A standard of care for tobacco users who need intensive treatment to
quit should be developed. (Gruman)
- The "5 As" must be institutionalized into health care
delivery systems. (Corr)
- Providers should be appropriately reimbursed for providing smoking
cessation counseling and treatment services to their patients. (Rand)
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Funding for tobacco use treatment research must be increased, specifically
in the following areas:
- Reaching populations at risk (Bailey)
- Reaching highly addicted tobacco users needing more intensive
treatments (Gruman)
- Teen specific interventions (Hoffman)
- Furthering our understanding of the addictive process, treatment
innovation, and the coordination of treatment access along with other
elements of tobacco control. (Henningfield/Bailey)
- Safer and more effective pharmaceuticals and behavior modification
models (Corr)
- Integration of intensive tobacco use cessation into health care
practice. (Gruman)
Findings from this and additional research must be translated into effective
tobacco control policies at the Federal, State and local level (Corr)
Following the public testimony, Michael Schooley, Secretary
for the Interagency Committee on Smoking and Health, thanked all those who
provided testimony, and encouraged everyone to follow their oral testimony
with written remarks. He also encouraged subcommittee members, testifiers
and observers to let others know about the two additional opportunities for
testimony in Denver and Chicago.
The meeting adjourned at 1:45 p.m.
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