NIH State of the Science SOS Conference on Tobacco Use Prevention, Cessation, and Control

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NIH State of the Science (SOS) Conference on
Tobacco Use Prevention, Cessation, and Control
12-14 June 2006, NIH Campus, Bethesda Md.

• Captain Larry Williams, DC, USN
• NHCGL, Great Lakes

Source NIH Conference attendance notes
and http//consensus.nih.gov/2006/2006TobaccoSOS02
9Program.pdf
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NIH SOS Key Areas of Focus

• Population and Community based interventions for
  adolescents
• Increasing consumer demand for cessation
  including diverse populations
• Effective strategies for increasing
  implementation in healthcare systems and
  communities
• Smokeless tobacco and harm reduction
• Effectiveness of cessation in populations with
  co-morbid conditions

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NIH SOS Background
Epidemiologic Model of Nicotine Addiction and
Tobacco Control
Environment (Social, family, work, etc.)
Agent (Actual product)
Vector (How it gets in)
Host (User)
Vector
Page 22, NIH Abstract Report, June 06
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NIH SOS Background

• Tobacco industry spends 50 per person each year
  on marketing, product development, and sales
• Approximately 2 for cessation
• Evidenced base for findings
• http//www.ahrq.gov/downloads/pub/evidence/pd
  f/tobaccouse/tobuse.pdf

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NIH SOS Health System Changes

• 30 cancer deaths tobacco related
• 20 all deaths tobacco related
• Get NRT into smaller doses
• Quitlines advertise smokeless cessation
  assistance
• Ask, Advise, Refer

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NIH SOS Smokeless Tobacco

• Big push by tobacco industry to look at smokeless
  tobacco (ST) as a safer alternative to smoking
• Uncontrolled/ varied levels of carcinogens in ST
• Medicolegal risks for providers
• Risks of cancer, oral disease, addiction
• Highly contentious issue but..
• Not a proven or approved alternative to smoking
  by any standard

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NIH SOS Population and community based
interventions for adolescents

• What do we know
• Price increase decreases tobacco use
• Laws and regulations are effective
• Mass media works (Truth)
• What we dont know
• Sustained effects of school-based programs
• Adult program tailoring
• Attention to culture specific issues

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NIH SOS Increasing consumer demand for
cessation including diverse populations

• What do we know
• Brief mass media education programs that are
  sustained work
• Effective with proactive telephone counseling
• Price increases are effective in broad range of
  SES groups
• What do we not know
• Tailoring of efforts to diverse groups
• Make cessation attractive

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NIH SOS Effective strategies for increasing
implementation in healthcare systems and
communities

• What do we know
• Incentives work
• Tobacco user identifiers
• Outreach (telephone, media, etc.)
• Better outsomes with health systems with
  dedicated cessation staff
• JCAHO and HEDIS measures may help increase
  cessation delivery
• What do we not know
• Why are smokefree work areas, pricing, and
  insurance coverage not more evident?
• How can we better measure successes?
• Can the electronic health record help?

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NIH SOS Smokeless tobacco and harm reduction

• What do we know
• ST use is increasing
• Product varies greatly
• Use of any tobacco product should be discouraged
• No evidence that the use of ST reduces harm
• What we do not know
• Scandinavian studies do not correlate to U.S.
• Data for using ST to help cessation is not
  available

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NIH SOS Effectiveness of cessation in
populations with co-morbid conditions

• What do we know
• Continued use of tobacco with co-morbid
  psychiatric and medical diseases complicates
  treatment
• Patients with asthma, HIV/AIDS, COPD, CVD, and
  cancer are adversely affected by ETS
• Tremendous treatment benefit with cessation for
  those with co-morbid conditions
• Persons with MDD may have long term cessation
  problems
• Psych patients may quit, but have difficulty with
  long term
• Cessation with substance abuse is effective
• Cessation during pregnancy has low success
• What we do not know
• Unknown tailoring benefit
• Unknown timing for cessation
• Unknown aspects of genetic predisposition

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NIH SOS Where is research needed

• Improve and implement effective interventions
• Improve and implement effective policies
• Develop new population and community based
  interventions
• Infrastructure
• Smokeless tobacco

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NIH SOS Conclusions

• Tobacco use remains a very serious public health
  problem
• Most adult tobacco users want to quit but only a
  few are offered or get help
• Many areas have implemented successful programs
  that need to replicated
• ST may harm the health of the US and must be
  better understood
• Prevention and cessation among youth are
  successful strategies
• Tobacco use is a critical and chronic condition
  that requires continuous attention and
  improvement from providers, healthcare
  organizations, and research groups