Helping Smokers Quit

Every year 443,000 people die from tobacco-related illnesses and secondhand smoke exposure. Children lose parents, spouses lose partners, and friends lose loved ones. There is also an economic element: employers lose employees, states lose taxpayers and productive citizens, and everyone pays higher health care costs.

Even more tragically, these losses are preventable. Kids can be prevented from starting to smoke, and current smokers can quit. Unfortunately, the U.S. has done very little to help smokers quit their powerful addiction to nicotine. Although most smokers want to quit, they often struggle and sometimes fail to quit for good. One of the reasons many smokers fail to quit is a lack of access to proven and effective treatments.

The American Lung Association believes that with the passage of health care reform, there is a historic opportunity to ensure that all smokers have access to treatments that can help them quit. State policymakers must take action to extend cessation coverage benefits even further as they implement provisions from the Patient Protection and Affordable

Care Act. Demand for assistance in quitting is also likely to increase, as more smokers are faced with an increasing number of smokefree laws and higher tobacco prices. Giving all smokers access to a comprehensive cessation benefit now is the right thing to do, and it is also the smart thing to do.

The Benefits of Helping Smokers Quit
Ask any smoker if they want to quit, and chances are they will say yes. Surveys show that over 70 percent of tobacco users want to give up tobacco. The Health effect of smoking are well known to most everyone—smoking increases a person’s chances of suffering from chronic diseases like chronic obstructive pulmonary disease (COPD), heart disease and lung and other cancers. Studies show that smokers’ lives are over 13 years shorter than nonsmokers’.

Quitting smoking also has economic benefits. Studies indicate that helping smokers quit saves thousands of dollars in health care expenditures per smoker. These savings in medical expenses benefit smokers, insurance companies, employers, and governments. In fact, a recent study conducted by Penn State University and released by the American Lung Association showed that states could save an average of $1.26 per every dollar spent on providing cessation treatments. Also, the money that a smoker spends on buying cigarettes can be spent on other things after the smoker quits.

The odds are also very good that any smoker who wants to quit will also tell you he or she has tried to quit before. In 2009, 47 percent of smokers reported trying to quit in the last year. Because the addiction to smoking is extremely powerful, only 4 to7 percent of smokers are successful each year in quitting.7 Many need to try multiple times to stop using tobacco products for good. Many also need help quitting—going “cold turkey” does not work for most people.

Fortunately, smokers can get help to quit. Seven treatments—both over-the-counter and prescription medications—have been approved by the U.S. Food and Drug Administration.

They are most effective when used with group, individual and phone counseling. However, policymakers at the federal and state level need to make sure that the right policies are in place for smokers to get all the help they need to quit.

American Lung Association Smoking Cessation Programs

The American Lung Association provides several programs that help tens of thousands of smokers quit every year. Freedom From Smoking® is considered to be the gold standard of smoking cessation programs and Not-On-Tobacco® is the country’s most widely used teen smoking cessation program. All of these programs include components of the intensive counseling interventions recommended in the Guideline. More information about these programs can be found at www.LungUSA.org.

Freedom From Smoking®
The Freedom From Smoking® program has been helping smokers quit for over two decades. The program is offered in three different formats. It began in 1980 as a self-help manual, which is still available today. The program is also offered as an eight-session group clinic in many areas of the country. Additionally, the American Lung Association offers Freedom From Smoking® Online (www.ffsonline.org), which takes smokers through the same recommendations online and provides interaction
with other smokers from across the country. All Freedom From Smoking® products are regularly reviewed and updated to make sure the program remains “America’s gold standard in smoking cessation programs.”

Participants in Freedom From Smoking® develop a personalized step-by-step plan to quit smoking. Each session uses a positive behavior change approach and encourages participants to work through the problems and process of quitting individually as well as in a group.
Evidence has shown that Freedom From Smoking® is very effective at helping smokers quit.

Lung HelpLine (1-800-LUNGUSA)

The Lung HelpLine is a valuable resource to anyone interested in and affected by lung health. The HelpLine is staffed by registered nurses, respiratory therapists and smoking cessation counselors. Callers can ask about a variety of lung-related topics—but around 70 percent of calls are related to tobacco cessation.

The Lung HelpLine can help callers quit smoking, and refer them to local programs and treatments that will also help. The nurses and therapists at the Helpline also answer questions submitted through the American Lung Association website.

Health Care Reform
The Patient Protection and Affordable Care Act (PPACA), enacted in March of 2010, will have far-reaching consequences in U.S. health care. The law had several provisions related to tobacco use and effecting tobacco users’ access to tobacco cessation treatments.

Medicaid
■■ Prior to enactment of PPACA, there were no national requirements for tobacco
cessation coverage in Medicaid for adults. Coverage decisions in this area were left up to the states, and states were allowed to exclude cessation treatment from coverage. Some states did just that.

■■ As of October 1, 2010, all state Medicaid programs are now required to cover a comprehensive cessation benefit for pregnant women with no cost-sharing. This benefit is to follow the recommendations of the U.S. Public Health Service Guideline. As of November 1st, CMS had not communicated to states what specifically they were required to cover.

■■ Congress did not include the rest of the Medicaid population in mandatory cessation coverage. This means many people on Medicaid still do not have access to a comprehensive cessation benefit. The adults left out of this provision
include Americans not of child-bearing age, the disabled, and mothers and fathers whose children are affected by secondhand smoke.

■■ Beginning January 1, 2013, Medicaid programs that voluntarily cover all preventive services recommended with an ‘A’ or ‘B’ by the U.S. Preventive Services Task Force (USPSTF)20 will receive a one percentage point increase in their federal matching rate for those services. Tobacco cessation services are given an ‘A’ by the USPSTF, so are included in this provision.

■■ Beginning January 1, 2014, state Medicaid programs will no longer be able to exclude tobacco cessation drugs from their prescription drug coverage. This provision will not guarantee coverage of all cessation drugs, however, and may not even guarantee placement on formularies or preferred drug lists.

Smoking Cessation Quitlines

States can also reach and help smokers through their tobacco cessation quitlines, which provide one of the three forms of counseling recommended in the Guideline. In 2004, the U.S. Department of Health and Human Services launched the National Network of Tobacco Cessation Quitlines Initiative. Since then, every state in the U.S., the District of Columbia, and Puerto Rico has operated a cessation quitline. These quitlines are available to anyone, regardless of insurance status. However, the specific services available from a quitlines (including phone counseling sessions and sometimes free or discounted medications) can vary depending on the insurance status of the caller (more sessions or medications available to uninsured, for instance), as well as the age of the smoker and other eligibility requirements. All tobacco users can reach their state quitline by calling 1-800-QUIT-NOW. This is a national number that will route the call to the tobacco user’s state.

According to the CDC, a well-funded quitline should:
1. Be available to all smokers wanting phone counseling;
2. Reach 8 percent of tobacco users in the state every year (measured by number of calls received from tobacco users);
3. Deliver services to 6 percent of tobacco users in the state every year (measured
by number of tobacco users who receive treatment); and
4. Offer two weeks of free NRT to all tobacco users. Four weeks should be offered
to uninsured or under-insured callers

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