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Turning the Tables on the Tobacco Industry by Creating a National Smokers' Registry

July 28, 2011: Cessation: Emerging Interventions and Innovations

K. Michael Cummings, Ph.D., M.P.H., Chairman, Department of Health Behavior, Roswell Park Cancer Institute

Dr. Cummings proposed that it could be possible to accelerate a decline in smoking by applying some of the same marketing approaches that the tobacco industry has used to recruit and retain smokers. One such approach would be to create a National Smokers' Registry by integrating data that are already captured though quitlines, on-line cessation services, healthcare providers, special events marketing and direct consumer appeals. Examples of how the tobacco industry has marketed and promoted products to consumers were shared with Committee members as a way to illustrate how the public health community could use similar tactics to reach smokers with cessation information. Dr. Cummings described a modest attempt at such a registry that was undertaken in the late 1990's that was able to enroll approximately eight percent of heavy smokers in 10 US cities.

If a National Smokers' Registry existed, it would be possible to directly market cessation services to participants. When smokers are offered free cessation medicine as well as the opportunity to win money if they are able to quit, they are very motivated to attempt to quit. A study conducted in New York sampled 121 smokers and asked whether being offered a free starter kit of nicotine patches and counseling led them to want to be transferred to the Quitline. Forty-one percent said that they were interested, with women being two times more likely to accept then males. Direct mail promotion to prompt calls to a quitline and access to free quit aides can also be very effective and evidence from New York has shown a large bump in call volume following such a promotion.

Dr. Cummings described a Smart Card system that is currently being implemented in Canada and how this, combined with interactive voice recognition software, has proven to be a cost effective model for providing cessation support and providing medications to interested smokers. Three scenarios for enrollment were described. In the first, when a client has no email and/or printer, a Smart Card would be sent through the mail and the client would activate it by calling a 1-800 number on the card. At that point, he/she would receive motivational messaging and could then redeem the card at a local pharmacy for two weeks of NRT. A follow-up call would be performed at some later point and the client could be triaged to the Quitline and offered more NRT through the reactivation of the Smart Card. A second scenario would enable a client to download and print his/her Smart Card and a third scenario would facilitate enrollment through a health care setting (replacing the fax-to-quit approach).

In conclusion, Dr. Cummings emphasized that the vast majority of smokers want to stop smoking and we need to find more cost effective ways to link them to evidenced based treatment resources. A National Smokers' Registry would allow for linkages across multiple recruitment channels into a scalable and flexible service delivery system that can reduce costs and eliminate duplication of services. With the new health warnings set to go on cigarette packs in 2012, the opportunity to launch a national smoker's registry is ideal.

Following Dr. Cummings' remarks, Dr. McAfee invited questions and comments. New York was congratulated on its effective use of media, and a Committee member echoed the idea that a smokers' registry and a centralized way to reach out to smokers is a great idea.

Surgeon General Benjamin thanked the panelists and opened the meeting for Committee member discussion. The Surgeon General began by commenting that the Interagency Committee should plan to meet more frequently given all that is underway in tobacco control on the federal, state and local levels.

Dr. Compton was asked about the age of study participants for the longitudinal study and he responded that participants will be adults 18 and older because of the difficulty of working with minors and trying to collect blood and urine samples from the youth population.

Dr. Teh-wei Hu, a Committee member from the University of California, Berkeley inquired about whether the U.S. was planning to ratify the Framework Convention on Tobacco Control treaty. Dana Shelton responded that the decision will be made by the Executive Branch but that many agencies are implementing provisions from the FCTC regardless of formal ratification.

Surgeon General Benjamin commented that the World Health Organization will be convening a high level meeting on non-communicable disease prevention and control in September 2011 in New York City. Tobacco use will be an area of focus due to its major contribution to cardiovascular disease, cancer and chronic lung disease—three of the four major non-communicable diseases. In addition, the recent National Prevention Strategy developed by the National Prevention Council (and Chaired by the Surgeon General) includes tobacco-free living as one of its seven priority areas.

Dr. Allan Noonan from Morgan State University thanked the Surgeon General for her leadership and commented that there needs to be more emphasis on tobacco use treatment in prisons. Although there are some smoke-free prisons, it would be very valuable to involve family members of those who are incarcerated in assisting their loved ones' efforts to quit.

Dr. Corinne Husten asked whether the federal government's tobacco-free campus policy is available on the HHS's website to serve as a best practice for others to replicate. The response was that it is not yet available on the web.

Dr. Michele Bloch from the National Cancer Institute emphasized how crucial it is that smokers understand that the earlier in life they are able to quit, the more likely they are to avoid disease and continued exposure to secondhand smoke. This is all the more reason that younger smokers need to be motivated through technologies such as those discussed by Dr. Augustson. Dr. Husten echoed the importance of expressing urgency around quitting and suggested that DHHS could give some thought to how this might be addressed. The Surgeon General noted that the upcoming Surgeon General's Report on youth tobacco use stresses the urgency of quitting as early in life as possible.

Following Committee member discussion, the Surgeon General opened the meeting for public comment.

Paul Billings, Vice President, National Policy and Advocacy for the American Lung Association urged the Department of Health and Human Services to include comprehensive coverage for tobacco cessation as an "essential health benefit" as part of the Affordable Care Act insurance package provisions to begin in 2014. Mr. Billings stated that Federal Employee Health Benefit coverage should serve as a model for all Americans so that they too can have full access to evidence-based tobacco cessation treatment with no co-pays or deductibles.

A second comment [NAME AND AFFILIATION UNKNOWN] was offered to suggest the use of QR (Quick Response) codes (a type of barcode designed to be read by smartphones) as an effective way to direct smokers to various websites to assist them in their efforts to quit.

Following public comments, Surgeon General Benjamin provided closing comments and first thanked all of the speakers for translating complex scientific information into understandable language and helping to identify what more needs to be known about the issue of tobacco dependence treatment. Dr. Benjamin also thanked the Committee members for their time and attention and commitment. The meeting served as a reminder about the need to continue to implement and disseminate proven cessation treatments and at the same time bring research to bear to develop even more effective tools to help smokers quit. It is crucial that we do everything possible to help the 45 million smokers in this country quit smoking for good.

The Surgeon General closed the meeting with a charge to continue to build on what was learned during the day's meeting and continue to implement what we know works.

The meeting adjourned at 4:30 pm.

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