Statewide Comprehensive Tobacco Cessation

1
Statewide Comprehensive Tobacco Cessation

• Wendy Bjornson, MPH
• Pacific Center on Health and Tobacco

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Why Hasnt Cessation Been a Higher Priority?

• Tobacco control movement started with research
  and campaigns to help people stop.
• Effective clinical methods were developed.
• Behavioral science - designed around a clinical
  behavioral model small group therapy.
• Effective medications were developed initially
  prescriptions, medical supervision were required
  added to clinical model.
• Clinical model was too limiting didnt meet
  needs of broad populations.

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Why Hasnt Cessation Been a Higher Priority?

• Population based policy approaches were
  discovered and found to be effective.
• Price increases
• ETS restrictions
• Advertising restrictions
• Sales to minors enforcement
• Initial experiments with population based
  cessation approaches were ineffective were not
  evidence-based.
• Clinical models too limiting population
  approaches ineffective. Conclusion Cessation
  doesnt work.

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Why is cessation becoming more of a priority?

• Despite ineffectiveness of first population based
  approaches, research has continued.
• Effective population based approaches have
  evolved Now, Cessation works.
• Implementation strategies have been developing
  somewhat separately beginning to come together.
• Momentum is building as effectiveness increases
  and as tobacco control movement changes poised
  to coalesce into a tobacco cessation movement.

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What are the changes in the tobacco control
movement?

• Changes in policies restricting smoking in public
  places together with price increases are
  motivating more tobacco users to try to stop.
• Tobacco control has been successful in
  stimulating more quit attempts.
• Most of these tobacco users try to quit on their
  own and most fail.
• Tobacco users are 2-3 times more likely to quit
  with help than on their own.
• Goal is to increase number of assisted quit
  attempts. New cessation strategies can work.

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Why is funding for cessation becoming a priority?

• Assistance to stop smoking costs 300 - 500
  (counseling and medications).
• Tobacco control advocacy for tax increases
  together with state economic problems have
  resulted in increased tobacco taxes in many
  states almost none of these revenues are used to
  help people stop smoking.
• Nationally,about half of tobacco users are
  economically disadvantaged cant afford help.

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What Do We Need to Do?

• Opportunity Cessation approaches can now help
  reach public health goals.
• Challenge Need programs and policies to set up,
  deliver, and finance evidence-based services with
  limited public funding.

HOW? Partnership approach to statewide
comprehensive tobacco cessation programs.
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Comprehensive Tobacco Cessation

• Evidence-based, state funded quitlines
• Cessation services in conjunction with community
  and health care services.
• Benefit coverage through employers, public
  insurance programs and other health care
  purchasers.
• Innovative and culturally sensitive community
  development and population based approaches to
  reach disparate populations

Health Community Services
Purchasers Employers
Quitlines
Community Development
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Quitlines

• Play a central role through
• Direct counseling
• Central resource for materials, information and
  referrals triage callers.
• Easily accessible, convenient, economies of scale
• Multi-language, culturally tailored services
• Trained staff quality assurance

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Health Care and Community Services

• Need system that makes advice and referral from
  health care professionals routine evidence
  based.
• Health and community services can make services
  integral part of clinic visits.
• Give personal advice
• Refer tobacco users who are ready for services
  (e.g.quitlines)
• Prescribe medications
• Record in charting systems
• Service delivery can be included in
  administrative and billing health information
  systems monitor for quality improvement.

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Benefit Coverage

• Benefits through
• Employers both public and private
• Publicly funded insurance programs Medicaid,
  Medicare, HIS, FQHCs, mental health and
  substance abuse programs.
• Need to build partnerships and demonstrate how
  effective tobacco cessation is a good investment
  in a health workforce.

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Community Development/Tailored Population-Based
Approaches

• Key issue for reaching disparate populations is
  how access to health services is affected by SES.
• About half of tobacco users in US are
  economically disadvantaged affects access and
  affordability of health services.
• Some economically disadvantaged also face
  cultural, language, geographic hurdles often
  missed by existing health services.
• Community development using creative partnerships
  are needed e.g.the health care safety net
  clinics.
• Tailored population-based approaches e.g.
  multi-language quitlines.

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Comprehensive Tobacco Cessation Strategy Two
Directions

• Develop service infrastructure.
• Develop a network of that links and promotes a
  variety of affordable services, including
  services reaching disparate populations, and that
  use multi-service quitlines.
• Develop partnerships that lead to increasing
  access to services through better coordination
  and systems changes.
• Conduct outreach campaigns public opinion and
  health care policy changes.
• Communication strategies that influence social
  norms for seeking and using services. Getting
  help is good vs.Do it yourself.
• Promote health care policy changes that increase
  benefit coverage.

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Comprehensive Tobacco Cessation

• Regardless of which strategic direction and
  projects are agreed on first, a central
  requirement is to make assistance to stop a
  higher priority among policy makers and funders,
  within health care, and among tobacco users.

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Getting Started

• First step create a state working group with
  dedicated staff.
• Role of the working group is to
• provide leadership.
• determine the initial strategic direction that is
  most suited to the resources and environment of
  the state.
• serve as a catalyst.

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Assessment

• Assess current needs including
• Quality and availability of cessation services.
• Funding and funding possibilities.
• Who is served and who is not.
• Policy environment.
• Determine strategic direction.

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Infrastructure Development Quitlines

• Fund and set up a quitline.
• Quitlines provide economy of scale and can serve
  as a centralized resource for services and
  information. (CDC Quitline Resource Guide.)
• Advocate for funding if not in place.

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Infrastructure Development Networks

• Reach out to health care and communities to link
  and/or expand existing services.
• Develop systems that promote referrals into
  health system services (and quitlines).
• Make services more available within health
  systems
• Make services available to uninsured.

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Networks Examples of Projects

• Massachusetts Quitworks referral project
• Arizona Helpline Client Referral Program and
  Provider Training
• Maine Medication Voucher Program and Provider
  Training
• Minnesota Health care referral partnerships
• Oregon Quitting Connection referral project

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Changing Health Care Systems and Policies

• Promote tobacco treatment as part of standard
  benefit for health insurers.
• Promote increased demand from employers for
  tobacco treatment in contracts with health
  insurers.
• Promote changes in public opinion leading to
  increased consumer demand.
• Advocate for tobacco treatment in government
  health care policies directed to priority
  populations.

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Changing Health Care Systems and Benefits
Policies Examples of Projects

• California Consortium of health care purchasers,
  insurers and providers collaborating on
  strategies and polices to make cessation a
  standard health care benefit.
• Oregon Make It Your Business outreach to
  employers and media advocacy campaign.
  (tobaccofreeoregon.org)
• North Carolina Prevention Partners outreach to
  businesses
• Federal legislation Medicaid, Medicare, MCHB

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Infrastructure Policy Changes to Reach
Disparate Populations

• Provide services for all tobacco users
• Includes specialized strategies for reaching and
  covering services for the uninsured and other
  disparate populations.
• Advocating for publicly funded services to
  include tobacco cessation assistance.
• Uses community development approaches to reach
  tobacco users who are not part of regular health
  care system.
• Uses tailored population based approaches such as
  multi-language quit lines.

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Disparities Examples of Projects

• California Help Line provides services in
  multiple languages.
• Washington quitline provides services and
  medications for the uninsured.
• Arizona community outreach to Hispanic and Native
  Americans.
• Alameda County smoking as a vital sign project
  in community health clinics.

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Strategies It Depends

• What is possible depends on what is happening and
  who is involved.
• Take advantage of opportunities.
• Include cessation focus in tobacco control
  campaigns e.g. part of enforcement of workplace
  restrictions earmarking of tobacco tax
  increases highlighting cessation services and
  quitline to help defend budgets.
• Partnerships with other health initiatives e.g.
  maternity and chronic disease case management.
• Business, union benefit contract negotiations.

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Strategies It Depends

• Leaders and partners can develop longer-term
  strategies for phasing-in cessation initiatives.
• Develop new messages.
• Polling to reframe smokers are bad messages to
  smokers have a right to treatment to help them
  quit. Note reframed messages are essential for
  working with new partners (e.g. employers, unions)

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PCHT Reports and Resources

• Available or coming soon on PCHT Website
  www.paccenter.org

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Pacific Center on Health and Tobacco

• Consortium of representatives from health
  departments, researchers, advocacy coalitions,
  health plans, and business from five western
  states California, Arizona, Oregon, Washington,
  Hawaii.
• National partners CDC, CTC, CTFK, SmokeLess
  States.
• Develop strategies for statewide tobacco
  cessation cessation approaches.
• Goal Promote widespread adoption of
  evidence-based methods for improving the
  availability and accessibility of tobacco
  cessation services.

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PCHT Members

• Arizona
• Dept of Health Services, TEPP
• Arizona Smokers Helpline
• University of Arizona
• California
• Bay Area Community Resources
• Integrated Healthcare Association
• Next Generation Tobacco Control Alliance
• California Department of Health Services
• California Smokers Helpline

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PCHT Members

• Hawaii
• Coalition for a Tobacco-Free Hawaii
• Hawaii Community Foundation
• Kalhi Palama Health Center
• Oregon
• Tobacco-Free Coalition of Oregon
• Oregon Department of Human Services, Health
  Services
• Oregon Research Institute

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PCHT Members

• Washington
• GHC Center for Health Promotion
• Department of Health
• Centers for Disease Control
• Center for Tobacco Cessation
• National Center for Tobacco-Free Kids
• SmokeLess States Project

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PCHT Contact Information
Wendy Bjornson, MPH, Director Pacific Center on
Health and Tobacco 1200 Naito Pkwy.
220 Portland, OR. 97209 [phone]
(phone) [phone] (fax) wendy_bjornson_at_qwest.
net