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SMOKING IS BAD FOR YOU

SMOKING IS BAD FOR YOU. ^ REALLY. Jennifer A Ericksen September 7, 2007. Outline. Smoking statistics & facts Health consequences Smoking cessation Benefits, stats, & what should be covered? What are plans covering? (ATMC Survey) Your options Questions/comments.

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SMOKING IS BAD FOR YOU

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  1. SMOKING IS BAD FOR YOU ^ REALLY Jennifer A Ericksen September 7, 2007

  2. Outline • Smoking statistics & facts • Health consequences • Smoking cessation • Benefits, stats, & what should be covered? • What are plans covering? (ATMC Survey) • Your options • Questions/comments

  3. Despite the Warnings… • 21% of U.S. adults (45.1 million people) are current cigarette smokers. • In the United States, 23% of high school students are current cigarette smokers. • Each day, about 1,140 persons younger than 18 years of age become regular smokers

  4. How Much Are We Spending? • U.S. spends > $167 billion per year • Lost productivity: $92 billion • Health care: $75.5 billion • Secondhand smoke costs: ~ $10 b annually • 2005: Industry spent ~ $13 b on advertising • States spend < 3% of $21.3 billion from excise taxes and legal settlements on preventing and controlling tobacco use

  5. Mortality & Morbidity • Worldwide: ~ 5 million deaths per year • > 10 million deaths annually expected by 2020 • Leading preventable cause of death in U.S. • ~ 1 / 5 deaths annually (~438K deaths/year) • ~ 38,000 deaths from secondhand smoke exposure • Shortened life span of ~ 13 to 14 years

  6. Cardiovascular Disease (Heart & Circulatory System) • Coronary heart disease: 2 - 4 X  risk • Doubles risk for stroke • >10 times more likely to develop peripheral vascular disease • Narrows blood vessels & reduces circulation • Abdominal aortic aneurysm

  7. Cancer • Second leading cause of death • 90% of lung cancer deaths in women • 13 times higher risk of death vs. never smokers • 80% of lung cancer deaths in men • >23 times higher risk of death vs. never smokers • Bladder, oral cavity, pharynx, larynx, esophagus, cervix, kidney, lung, pancreas, and stomach, and acute myeloid leukemia • Rates of cancers generally highest in AA men

  8. Respiratory Disease, Etc. • COPD: 10 X increased risk of death • 90% deaths attributable to cigarette smoking • Reproductive and early childhood effects • Increased risk for infertility, preterm delivery, stillbirth, low birth weight, and sudden infant death syndrome (SIDS) • Women • Lower bone density • Increased risk for hip fractures

  9. Health Benefits of Cessation • Reduced risk of dying prematurely • Lowers risk for lung and other types of cancer • Risk declines with number of years since smoking cessation • CHD risk substantially reduced within 1 to 2 years • Reduces coughing, wheezing, and SOB • Slower rate of decline in lung function • Reduced risk for adverse reproductive outcomes

  10. A Very Important Organ…

  11. They Want To Quit! • 70% want to quit completely • 2005: ~19.2 million (42.5%) adult smokers had stopped 1 day in last 12 months • 2005: ~46.5 million former smokers • > 54% of U.S. high school smokers tried to quit smoking within the preceding year

  12. Areas For Improvement • National Tobacco Control Program goals: • Promote cessation among people of all ages • Prevent initiation of tobacco use among adolescents • Reduce exposure to secondhand smoke • Identify disparities related to tobacco use and its effects among different population groups

  13. Coverage of tobacco-use cessation treatment increases both use of effective treatment and the number of successful quit attempts.

  14. Public Health Service & Community Preventive Services Task Force • All health plans should provide: • Counseling and medications • ≥ 4 counseling sessions of ≥ 30 minutes each • Rx and OTC nicotine replacement medication • At least two smoking cessation attempts per year • Eliminate or minimize co-payments or deductibles

  15. Hard to Believe… Although 66% of Americans under the age of 65 are insured through an employer, only 24% of their employers offer any coverage for tobacco-use treatment.

  16. How Much Do Cessation Benefits Cost? Are They Cost-Effective? • More cost-effective than other interventions • HTN & Hyperlipidemia programs • Cost/expenditure: Benefits > costs by 5 years • 10 to 40 cents PMPM for comprehensive benefit • Annual cost of tobacco use: ~ $3,400 per smoker or about $7.18 for each pack of cigarettes sold • Neonatal health care costs: $704 for each maternal smoker • Program for pregnancy saves ~ $6 for each $1 spent

  17. Addressing Tobacco in Managed Care Program: Survey • Program mission: To advance integration of tobacco cessation strategies into routine health care within health plans • Survey of tobacco control practices and policies in health insurance plans • Surveyed 1997, 2000, 2002, 2003 • 160/215 plans (74%) completed survey • >60 million HMO members represented

  18. What Are Health Plans Doing? ATMC Survey Results • Written clinical guideline: 67% • Identification of at least some members who smoke: 89% • Health-risk appraisals & phone surveys** • Enrollment data used by 12% • 15% in 1997 • Identification of all smokers: 3% • Full coverage for ≥ 1 pharmacotherapy: 88% • Bupropion most common: 83% • 25% in 1997

  19. ATMC Survey Results… • ≥ 1 behavioral intervention: 72% • Self-directed online resources** • Individual counseling during pregnancy • Telephone counseling • Other self-help materials • Larger plans** • Self help materials & pregnancy • Smaller plans** • Phone & face-to-face counseling

  20. ATMC Survey Results… • “Teachable moments” • Participation in management program forother diseases: 91% • Pregnancy: 69% • Treatment for chronic illnesses: 65% • Following myocardial infarction: 56% • Provider education: 50% • Coupled with prompts & reminders: 21%

  21. What Stands in the Way? • Health system barriers • Resources: • Staff, funding, competing priorities • System: • Data collection, reporting, records • Provider compliance • Purchaser demand • Delayed economic return on investment • ROI analysis tool now available online

  22. It’s Your Turn… • Kaiser Cessation Program • Get a Rx from your physician • Participate in smoking cessation class every 2 weeks for 6 weeks • Just pay your normal drug co-pay! • Telephone counseling at 1-800-NO-BUTTS • Visit kp.org/quitsmoking or contact your local health education center

  23. Don’t Give Up Giving Up…

  24. References • CDC Website • McPhillips, et al. Addressing Tobacco in Managed Care: Results of the 2003 Survey Preventing Chronic Disease, July 2006 • Kaiser Permanente Website and Health Education Center

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