Examples of Policies that Promote Heart–Healthy and Stroke–Free Communities for State Legislators

Assess the value of increasing excise taxes on tobacco products in your state

New York City became the first community in the nation to meet the HealthyPeople 2010 objective of increasing the cigarette excise tax to $2 per pack. As a result, the combined federal, state, and local taxes total $3.39 on each pack of cigarettes. The effectiveness of this tax hike is reflected in declining rates of cigarette smoking among high school students. Nearly 33% of high school students smoked cigarettes in 1997, but this percentage declined to 26.8% by 2000, according to the New York State Youth Tobacco Survey. Because most cigarette smokers begin smoking by age 18, preventing tobacco use among young people is critical to the overall goal of reducing the prevalence of smoking. Adult smoking rates have also decreased dramatically in New York in recent years as a result of the tax increase along with stricter indoor smoking laws and free nicotine replacement therapy. Programs like the New York State Tobacco Control Program play pivotal roles in reducing and eliminating tobacco use among state residents.

Support data collection efforts and the sharing of data that can document progress in preventing heart disease and stroke and their related risk factors

In 2000, Wisconsin’s Cardiovascular Health Program collaborated with a statewide group of HMO’s and health systems, as well as other public and private heath organizations to increase the percentage of patients who have high blood pressure controlled. Participating HMOs represented 84% of the people enrolled in HMOs in the state in 2000 and more than 98% of those enrolled in 2001. The Cardiovascular Health Program asked the 20 participating health plans with commercial enrollees to collect four cardiovascular–related measures from the Health Plan Employer Data and Information Set (HEDIS). These data provided a baseline assessment for planning quality improvement strategies within the health plans. Only 48% of patients with a history of high blood pressure in the participating health plans were found to have their high blood pressure controlled. On the basis of this information, the health plans put into place strategies to improve blood pressure control. As a result, by 2003, 62% of patients had their high blood pressure controlled—a relative increase of nearly 30% over 3 years. By working with other health systems and organizations and sharing quality improvement data, the cardiovascular health program provided a population–based perspective that promoted health system changes and led to better health outcomes.

Publicly support a statewide quitline to provide all smokers with the support and latest information to help them quit

The state of California implemented a Smokers' Helpline in 1992. It is available in six languages (English, Spanish, Mandarin, Cantonese, Vietnamese, and Korean) and through a TTY line for the hearing impaired. Specific protocols are used depending on whether the caller is an adult, teen, or pregnant smoker. The Helpline currently serves about 45,000 callers per year, 34% of which are from ethnic minority groups. The quitline's protocol has been shown to be effective through a large randomized trial. This trial found that smokers who receive multiple telephone counseling sessions have a higher one–year quit rate than those who receive only one session or who rely on self–help approaches. These results have been replicated in another study that applied the protocol in a "real world" setting. One of the challenges faced in California has been increasing physician referrals of smoking patients to the Helpline. One useful strategy used in California is to acknowledge clinicians' time constraints in providing cessation counseling and to offer the Helpline as a way to ease some of this burden. Letters are periodically sent to physicians who have referred patients to the Helpline thanking them and indicating how many of their patients have called the Helpline due to referrals.
 

Date last reviewed: 05/12/2006
Content source: Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion