Getting to Quit: Smoking Cessation Initiatives Women in Government National Legislative Conference June 22, 2018 KATRINA F. TRIVERS, PHD, MSPH LEAD EPIDEMIOLOGIST OFFICE ON SMOKING AND HEALTH 1
Acknowledgements Lei Stephen Zhang, PhD, Health Scientist Babb, MPH, Public Health Analyst 2
Overview Cessation: What Works Barriers: What Hurts Resources & Conclusions 3
Tobacco use is the single most preventable cause of disease, disability, and death in the U.S. 480,000 Cigarette smoking kills about 480,000 people in the U.S. each year. 1 $300B Cigarette smoking costs the U.S. more than $300 billion annually. 1,3 About two in every five children are exposed to secondhand smoke. 2 2 in 5 1 vs. 30 For every one smoking-related death, at least 30 people live with a serious smoking-related illness. 1 1. U.S. Department of Health and Human Services. The Health Consequences of Smoking 50 Years of Progress: A Report of the Surgeon General.(https://www.cdc.gov/tobacco/data_statistics/sgr/50thanniversary/index.htm) Atlanta, 2014. 2. Homa D, Neff L, King B, Caraballo R, Bunnell R, Babb S, Garrett B, Sosnoff C, Wang L. Vital Signs: Disparities in Nonsmokers Exposure to Secondhand Smoke United States, 1999-2012. MMWR 2015;64(04):103-108. 3. Xu X, Bishop EE, Kennedy SM, Simpson SA, Pechacek TF. Annual healthcare spending attributable to cigarette smoking: an update. Am J Prev Med 2015; 48(3):326-33.
Percent (%) The Good News: Cigarette Smoking Is Down 60 51.9 Men Women 50 40 33.9 30 20 10 2016 16.7% 17.5 13.5 0 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 Year Note: Estimates since 1992 include some-day smoking. Source: 1965-2014 data from National Health Interview Survey (NHIS). Jamal A, Phillips E, Gentzke AS, et al. Current Cigarette Smoking Among Adults United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:53 59. DOI: http://dx.doi.org/10.15585/mmwr.mm6702a1 5
The Bad News: Disparities in Smoking Persist Race/Ethnicity 31.8% American Indians/Alaska Natives 16.6% White Education level 40.6% GED 4.5% Graduate degree Poverty status 25.3% Below poverty line 14.3% At or above poverty line Health insurance coverage 28.4% Uninsured 25.3% Medicaid 11.8% Private 10.2% Medicare Disability/limitation 21.2% Yes 14.4% No Sexual orientation 20.5% Lesbian/Gay/ Bisexual 15.3% Heterosexual Serious psychological distress 35.8% Yes 14.7% No Source: Jamal A, Phillips E, Gentzke AS, et al. Current Cigarette Smoking Among Adults United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:53 59. 6
The Evolving Tobacco Product Landscape Cigarettes Cigars, Cigarillos Little Cigars Smokeless Pipes Snus Tobacco Hookah Bidis Dissolvables Kreteks ENDS Heated Tobacco Products 7
Framework for Increasing Cessation Health systems change Expansion of cessation insurance coverage State quitline capacity: 1-800-QUIT-NOW Part of comprehensive approach of population-based interventions to drive cessation: price increases, smoke-free policies, hard-hitting media campaigns Sources: Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs 2014. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. King BA, Graffunder C. The Tobacco Control Vaccine: a population-based framework for preventing tobacco-related disease and death. Tob Control. 2018 Mar;27(2):123-124. 8
What Works for Cessation I m Ready to QUIT! Evidence-based cessation treatments that increase quit rates among adult cigarette smokers include: Brief advice to quit from a health care professional Individual, group, and telephone counseling and 7 FDA-approved medications Providing health insurance coverage for these cessation treatments Source: Fiore MC, Jaen CR, Baker TB, et al. (2008). Treating tobacco use and dependence: 2008 update. U.S. Public Health Service Clinical Practice Guideline. Rockville (MD): U.S. Department of Health and Human Services, 2008. 9
How Are We Doing With Quitting? Wanted to stop smoking Made a past-year quit attempt Recently quit smoking Who had seen a health professional in the past year had been advised to quit Used cessation counseling and/or medication when trying to quit Who had ever smoked had quit Source: Babb S, Malarcher A, Schauer G, Asman K, Jamal A. Quitting Smoking Among Adults United States, 2000 2015. MMWR Morb Mortal Wkly Rep 2017;65:1457 1464. 10
Proportion of ever smokers who have quit: Quit ratio (former/ever smokers) National Health Interview Survey, 1965-2015 % 2002 is the first time more than 50% of people who had ever smoked had quit 1965-1990 Source: National Health Interview Survey 11
Disparities in Quitting Past-year quit attempts were lower in whites than in Asians and Blacks. Hispanics and Asians were less likely than whites to: o Receive advice to quit o Use cessation counseling and/or medication Gay/lesbian/bisexual smokers were markedly less likely than straight smokers to report using cessation counseling and/or medication. Recent cessation increased with education level. Uninsured smokers were less likely than smokers with private health insurance to: o Receive advice to quit o Use cessation counseling and/or medication o Quit successfully 12 Source: Babb S, Malarcher A, Schauer G, Asman K, Jamal A. Quitting Smoking Among Adults United States, 2000 2015. MMWR Morb Mortal Wkly Rep 2017;65:1457 1464
Medicaid Coverage of Cessation Treatments (Lung Association Cessation Coverage) in Effect as of March 31, 2018 Comprehensive Coverage Less Than Comprehensive Coverage Source: CDC. State Tobacco June 1, 2018. Activities Tracking and Evaluation (STATE) System. https://www.cdc.gov/statesystem/comprehensivemedicaid.html. 13
Barriers to Medicaid Coverage Copayments required Prior authorization required Counseling required for meds Stepped-care therapy Limits on duration Annual or lifetime limit on quit attempts Source: DiGiulio A, Jump Z, Yu A, Babb S, Schecter A, Williams KS, Yembra D, Armour BS. State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments - United States, 2015-2017. MMWR Morb Mortal Wkly Rep. 2018 Apr 6;67(13):390-395.
Elements of Health System Change to Increase Quit Attempts and Success Barrier-free/evidence-based comprehensive cessation insurance coverage o Both public and private o Crafting the right benefit barrier-free! Healthcare systems changes o Prompt, guide, and incentivize tobacco treatment o Meaningful use/ Electronic Health Records o Clinical Quality Measures Proper evaluation 15 15
Additional Resources 17
Takeaways Tobacco use continues to create 1 2 a considerable health and economic burden in the United States. Proven cessation interventions exist but are underutilized. It is important to treat tobacco dependence as a chronic condition. 3 Progress has been made in cessation. Almost three in five U.S. adults who ever smoked have quit. However, there is room for improvement. 18
Katrina F. Trivers, PhD, MSPH Office on Smoking and Health fph1@cdc.gov (404) 498-6861 www.cdc.gov/tobacco For more information, contact CDC 1-800-CDC-INFO (232-4636) TTY: 1-888-232-6348 www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.