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August 14, 2001: Smoking Cessation: Facing the Challenges of Tobacco Addiction

David Satcher, MD, PhD, Assistant Secretary for Health and Surgeon General

Dr. Satcher welcomed members of the Interagency Committee on Smoking and Health (ICSH) and other attendees to the meeting. As a slight change to the agenda, Dr. Satcher asked each committee member to introduce him or herself with name and affiliation (see list of participants), and he then asked all meeting participants to do the same. Dr. Satcher stated that he would offer some remarks, and would then ask the committee members to offer any additional comments or agency updates after those remarks.

Dr. Satcher gave a brief history of the Interagency Committee on Smoking and Health (ICSH), which was established by Congress under the authority of the Comprehensive Smoking Education Act of 1984. The committee reports to the Secretary of Health and Human Services (HHS) through the Surgeon General and is staffed by the Centers for Disease Control and Prevention's (CDC) Office on Smoking and Health (OSH). The committee is charged with helping to coordinate HHS and other federal research, educational programs, and other activities related to smoking and health, and provide a liaison function to appropriate private organizations and federal, state, and local public health agencies regarding smoking and health activities.

Dr. Satcher stated that since the group had last met in October 2000, there had been a number of milestones that he would briefly review:

  • The release of the Surgeon General's Report on Women and Smoking in the spring of 2001. Dr. Satcher and HHS Secretary Tommy Thompson were very pleased with the attention the report received in the media, at professional conferences, among the leadership of women's organizations, and by national legislators. Dr. Satcher thanked committee members and other participants for their involvement in bringing attention to the issue of women and smoking.

    On the issue of women and smoking, a study conducted by the American Council on Science and Health indicated a need for greater support from popular and women's magazines. These magazines have shown a commitment to covering general health issues, but they have failed to cover lung cancer, the number one cause of cancer death in women. In addition, they publish a significant number of cigarette ads while at the same time they neglect to include basic information on the health-related consequences of cigarette smoking. Dr. Satcher reported that the previous day he had participated in a meeting in New York City with 80 editors of women's magazines to discuss some of these issues. He said it had been a very positive meeting, and it is an effort in which he will continue to be involved.
  • A second milestone was the CDC's report and satellite broadcast on State Investments in Tobacco Control. Dr. Satcher mentioned that states are spending over $880 million on tobacco control activities, representing $3.38 per capita. While this figure is impressive, it is less than one eighth of the amount spent by the tobacco industry on promoting its products each year. Not only are states spending on average only 60% of the funding that CDC recommends as a minimum for a comprehensive state tobacco control program, but only 7 states are funding these programs at the CDC-recommended minimum levels—Arizona, Indiana, Maine, Massachusetts, Mississippi, Ohio and Vermont.

    Dr. Satcher went on to say that state program funding comes from settlement agreements with the tobacco industry, excise taxes, general revenue, federal, and private sources. In five states, federal and private funds (including CDC's National Tobacco Control Program and the American Legacy Foundation) are the only funds being invested in tobacco control. In at least 20 states, they make up 50% more of the funds being invested. Comprehensive tobacco use prevention and control programs reflect sound investments for states, and will lead to reduced disease burden from tobacco.

    Dr. Satcher highlighted successes in three states based on comprehensive tobacco use prevention and control programs:
    • California data indicate that sustaining an adequately funded and comprehensive program for at least nine years can result in reductions in lung and bronchial cancer and coronary heart disease rates. Specifically, according to CDC statistics, the program in California was associated with 33,000 fewer deaths from heart disease between 1989 and 1997 than the number that would have been expected. While lung cancer cases were rising by 13% nationally, there was a reduction by 5% in California, which is truly tangible evidence of the effectiveness of comprehensive tobacco control programs.
    • Oregon demonstrated that students in school districts funded to implement comprehensive school programs (based on CDC's school tobacco use prevention guidelines) were about 20% less likely to smoke than students in nonfunded schools. In addition, among funded schools, there is a strong dose-response effect between how fully schools implemented CDC's guidelines and how much smoking rates declined.
    • Florida's youth tobacco control program has made striking progress in changing youth attitudes toward tobacco. The Florida youth antismoking program includes counter-marketing and communication, education, and training, youth and community partnerships, enforcement, and evaluation and research efforts. Between 1998 and 2000, these efforts contributed to an increase in the percent of students who are likely to remain smoke-free by about 40% for middle and 46% for high school students.
  • Third, the Institute of Medicine released a report entitled Clearing the Smoke which describes the scientific methods and standards for assessing whether some tobacco products are less harmful than others. A multisector group, headed by the National Cancer Institute (NCI), convened a meeting in spring 2001, to foster scientific discussion of this topic.
  • Finally, on April 10, 2001, the U.S. Office of Personnel Management took action to encourage Federal Employee Health Benefits Plans to include smoking cessation coverage in their plans. This action will provide access for federal employees to cessation services that meet the Public Health Service (PHS) guidelines that were published a year ago. Dr. Satcher added that this effort would provide an opportunity to evaluate the impact of adding services, which could save money in the long term. He mentioned a similar effort undertaken last year to look at parity for mental health services and the attempt to demonstrate that these services will not be more costly and will also increase productivity.

Dr. Satcher commented that as Surgeon General he has a special interest in smoking cessation. In November 1999, tobacco control was recognized as one of the ten greatest public health achievements of the century in the United States. This reflects the dramatic reduction of smoking prevalence among persons aged 18 years and older from about 42% in 1965 to almost 25% in 1997. Even with these reductions, tobacco remains the leading cause of preventable mortality.

Dr. Satcher went on to talk briefly about Healthy People 2010—and how reducing tobacco use is a key component of this national action plan for improving the health of all Americans during the first decade of the 21st century. There are 21 national health objectives related to tobacco use, covering tobacco use in population groups, cessation and treatment, exposure to secondhand smoke, and social and environmental changes. Furthermore, reducing tobacco use is one of Healthy People 2010's 10 Leading Health Indicators. Dr. Satcher asked committee members whether they were familiar with the Leading Health Indicators, five which focus on lifestyle issues and five on health systems issues. HHS will be monitoring progress with the Leading Health Indicators throughout the decade and will report on progress in reducing tobacco use. To attain all of the Healthy People 2010 tobacco use objectives, including one to cut smoking rates among teens and adults in half, will require a national commitment to implementing approaches to tobacco use prevention and control that have been proven effective. Because we know what works, Dr. Satcher charged the group with making a commitment to help implement what works to achieve our national objectives.

The Surgeon General mentioned an article included in the ICSH briefing books describing the American Cancer Society's (ACS) goal to reduce cancer incidence by 25% and cancer mortality by 50% by 2015. The article concludes that 100,000 cases of cancer and 60,000 deaths from cancer could be prevented each year by redoubling efforts to reduce the prevalence of smoking and other known cancer risk factors. Dr. Satcher mentioned that as we set measurable objectives and begin to launch comprehensive programs, he is hopeful that we can achieve our goals.

Dr. Satcher ended his comments by giving a brief overview of the agenda and some of the issues that would be covered in the meeting. Speakers would talk about what is known about smoking cessation and how to move forward in this area, as well as the large number of cessation-related research, education and other activities underway in the federal government, states and the private sector. For example—

  • Clinical and community guidelines published by HHS that identify effective interventions for clinicians, health care systems, and communities
  • The Center for Medicare and Medicaid Services' pilot study to cover the cost of Medicare cessation services
  • Perspectives from two states and one large business about their experiences in implementing cessation services
  • The role of quitlines (national and state) and the cessation research agenda, especially as it relates to youth

Dr. Satcher ended his opening remarks by talking about his excitement at the opportunities for partnership between HHS and other federal departments as well as nonfederal colleagues in the area of smoking cessation. He welcomed input from the committee and other participants about ways that HHS can better coordinate these efforts and address the challenges and barriers to smoking cessation so that community and individual-based smoking cessation programs are implemented in all communities across the country.

Following his introductory remarks, Dr. Satcher asked committee members if they had any brief comments regarding new or significant tobacco activities at their organizations. Anthony So, M.D., M.P.A., (Rockefeller Foundation) mentioned his interest in the issue of health equity, and how we can better address the lowering of prevalence among the disadvantaged so that they are not left behind in our efforts. Dr. So also mentioned his interest in the continuum of care for tobacco use treatment, from physician-initiated advice to quitting with follow-up efforts and how these can be sustained.

Pauline Lapin, M.H.S., (Center for Medicare and Medicaid Services) said that she was pleased to be included in the committee because so often seniors are overlooked in tobacco cessation efforts, yet they stand so much to gain.

Aaron Primack, M.D., M.A., F.A.C.P., (Fogerty International Center at NIH) introduced himself and said that he was there for Gerald Keusch, who would most likely join the meeting later in the day. He mentioned the recent RFA for global tobacco control efforts, available on the NIH Web site, about which there has been tremendous excitement and enthusiasm.

Rosemary Rosso, Esquire, (Federal Trade Commission) stated that she was pleased to be involved.

Scott Leischow, Ph.D., (National Cancer Institute) talked about NCI's interest in translating research into improved outcomes and how to best use data to improve health systems.

Susannah Ali, (Office of the Assistant Secretary for Planning and Evaluation) told the committee that she was pleased to be involved to learn from recent advancements.

Anita Schill, Ph.D., M.P.H., (National Institute for Occupational Safety and Health) said that environmental tobacco smoke was of particular interest to NIOSH given its mission.

Lee Wilson, (Substance Abuse and Mental Health Services Agency) told the committee that SAMHSA is the largest provider of public funds for substance abuse block grants to the states and he believes it is important that tobacco control and substance abuse efforts become better coordinated.

Christine Williams, (Agency for Healthcare Research and Quality) briefly mentioned the Public Health Service's Clinical Practice Guidelines, about which she would speak later in the day.

Catherine Lorraine, (Food and Drug Administration) stated that although the FDA's program had been shut down after last year's Supreme Court decision, the agency continued to be committed to the goal of tobacco use prevention and control—and particularly youth cessation—and would be pleased to provide scientific expertise to sister agencies.

Glenn Bennett, M.P.H., C.H.E.S., (National Heart, Lung and Blood Institute) reported NHLBI's interest in collaboration in the areas of research, education, and dissemination.

Lynn Haverkos, (National Institute of Child Health and Human Development) explained that tobacco control is relevant to NICHHD's mission to ensure children are born healthy and have the opportunity to live unhampered by disease and disability.

Debra Grossman, M.A., (National Institute on Drug Abuse) confirmed NIDA's commitment to funding research on tobacco cessation.

Nancy Kaufman, R.N., M.S., (Robert Wood Johnson Foundation) mentioned the Foundation's more than 10-year involvement in tobacco control efforts including major work in the area of cessation. Ms. Kaufman mentioned that later in the day she would announce a new collaboration with HHS in this area. She also told the group her interest in the issue of access to high quality tobacco use treatment and how we might better package effective treatments while at the same time lowering the cost to individuals.

Lawrence Green, Dr.P.H., (Centers for Disease Control and Prevention) reported that the Office on Smoking and Health was charged with staffing the ICSH and was pleased to do so. Dr. Green emphasized how important it is that we focus on cessation if we hope to achieve our Healthy People 2010 objectives for the nation. While youth prevention efforts are important, they alone will not enable us to achieve these goals and that is why CDC is returning to a strong emphasis on cessation.

Susan Rossi, Ph.D., M.P.H., (National Institutes of Health) emphasized NIH's primary role as being research-focused, and was interested in identifying gaps for further research and greater coordination in these research efforts.

Linda Bailey, J.D., M.H.S., (Centers for Disease Control and Prevention) announced that the report from the meeting would be available on CDC's Web site later in the fall. Prior to that, all speakers would have an opportunity to check the document for accuracy.

Following the member comments and with no additional questions, Dr. Satcher introduced the first speaker.

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