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The National Action Plan for Tobacco Cessation – A 2007 Status Report

May 4, 2007

Michael C. Fiore, MD, MPHProfessor of MedicineDirector, Center for Tobacco Research and InterventionUniversity of Wisconsin School of Medicine and Public Health

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Support

National Institutes of Health (NIH) Transdisciplinary Tobacco Use Research Centers (TTURC) Program

Robert Wood Johnson Foundation (RWJF) Innovators Combating Substance Abuse Program

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Click to edit Master title style

Prevalence in Cigarette Smoking* Among Adults – United States, 1965-2004

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1965 1968 1971 1974 1977 1980 1983 1986 1989 1992 1995 1998 2001 2004

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Source: National Health Interview Surveys; selected years, United States—1965-2004 Behavioral Risk Factor Surveillance System , California—1984-2004*Estimates since 1992 include some-day smoking

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Cigarette Smoking Among Adults in U.S., 2004

Current Smokers 20.9% 44.5 million

Former Smokers 21.5% 45.6 million

Never Smokers 57.6% 212.7 million

Source: MMWR 11/11/05

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Key Milestones in Treating Tobacco Dependence

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1964

First Surgeon General’s Report directly linking smoking to lung cancerin men.

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Key Milestones in Treating Tobacco Dependence

1950-1970s 1950s – First scientific reports linking tobacco use

with cancer 1964 – First Surgeon General’s Report directly linking

smoking to lung cancer in men 1970s – Counseling strategies, including group and

individual, for smoking cessation 1970s – Aversive smoking studies completed

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Key Milestones in Treating Tobacco Dependence

1980-1990s Early 1980s – Nicotine Gum approved for tobacco

cessation 1988 – Surgeon General’s Report documents nicotine as

addictive 1990s – Nicotine patch and other nicotine replacement

medications approved by FDA 1991 – Smoking status recommended as the fifth vital

sign 1996 – AHCPR Clinical Practice Guideline #18 – Smoking

Cessation release 1996 – Bupropion approved by FDA

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Key Milestones in Treating Tobacco Dependence

2000-Today 2000 – S.G. Report on Cessation 2000 – PHS Clinical Practice Guideline – Treating

Tobacco Use and Dependence 2004 – National Action Plan for Tobacco Cessation 2005 – National Quitline Network 1-800-QUIT NOW 2006 – Varenicline approved by FDA 2006 – Tobacco Industry found guilty of racketeering 2008 – Proposed PHS Clinical Practice Guideline –

Treating Tobacco Use and Dependence Update

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2004

National Action Plan for Tobacco Cessation

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National Action Plan to Tobacco Cessation – Key Features

Designed to result in meaningful reduction in tobacco use and its effects

Science-based Addresses disparities National in scope, regional in application Public Private Partnerships

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National Action Plan to Tobacco Cessation – Key Features (continued)

Impact must be both immediate and sustained

Comprehensive & integrated Evaluated Securely funded

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Recommendation #1

Establish a federally-funded National Tobacco Quitline network by FY 2005 that will provide universal access to evidence-based counseling and medications for tobacco cessation. This quitline would provide a national portal to available state or regionally managed quitlines.

Estimated Cost: $3.2 billion/year

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National Network of Tobacco Cessation Quitlines

Launched by DHHS in 2004– Built on existing state quitline infrastructure– $25 million in Federal funds– Joint CDC and NCI initiative

By the end of 2005, all states had quitlines Challenges: funding; reach

1-800-QUIT NOW

(1-800-784-8669)

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Recommendation #2

Launch an ongoing, extensive paid media campaign by FY 2005 to help Americans quit using tobacco.

Estimated cost: $1 billion/year

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National Paid Media Campaign

“Be a Quitter Campaign” (NCI)– Target audiences: young adults age 18-29, active

and returning military, and low SES– Television and radio PSAs in English and Spanish– ABC & USA networks agreed to broadcast the

PSA in March– URL: www.1800quitnow.org

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National Paid Media Campaign (continued)

“Become an EX” campaign (American Legacy Foundation)– Target audience: “weary smokers”– Campaign being pilot tested in Buffalo, NY; San

Antonio, TX; Grand Rapids, MI; Baltimore, MD– Hope to disseminate nationally through

partnerships and collaboration– URL: www.becomeanex.org

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Challenges– Resources

State quitline funds for promotion decreased from an average of $325,000 in 2004 to $193,750 in 2005

States with newer quitlines or less well funded quitlines reported few or no funds for promotion

– Reach What media are smokers using and how can this be

harnessed to foster a quit attempt?

National Paid Media Campaign (continued)

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Recommendation #3

Include evidence-based counseling and medications for tobacco cessation in benefits provided to all Federal beneficiaries and in all federally-funded healthcare programs by FY 2005.

Estimated cost: $0.47 to 0.73 PMPM

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Coverage of Tobacco Dependence Treatment for all Federally-Covered Lives

Medicare: coverage provided for cessation counseling (2005) and prescription medications (2006)

Medicaid: 42 state programs provided at least some coverage (2005)1

VA: co-payments eliminated for counseling (2006)

1CDC, 2006

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Recommendation #4

Invest in a new, broad, and balanced research agenda (basic, clinical, public health, translational, dissemination) by FY 2005 to achieve future improvements in the reach, effectiveness and adoption of tobacco dependence interventions across both individuals and populations.

Estimated cost: $500 million/year

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New Tobacco Research Infrastructure

Opportunities: program announcements from NIH, CDC, and AHRQ; NIH Roadmap initiative, the TTURC initiative

Challenge: reductions in federal funding for research overall

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Recommendation #5

Invest in training and education by FY 2005 to ensure that all clinicians in the United States have the knowledge, skills and support systems necessary to help their patients quit tobacco use.

Estimated cost: $500 million/year

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New Tobacco Training Infrastructure

Opportunities: state-level programs and initiatives for tobacco dependence treatment training

Challenges: no coordinated, federally supported infrastructure

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Recommendation #6

Establish a Smokers’ Health Fund by FY 2005 by increasing the Federal Excise Tax on cigarettes by $2.00 per pack (from the current rate of $0.39 to $2.39) with a similar increase in the excise tax on other tobacco products. At least 50% of the new revenue generated by this tax increase (at least $14 billion of the estimated $28 billion generated) should be earmarked to pay for the components of this action plan.

Est. revenue generated: $28 billion/year

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Increased Federal Excise Taxon Cigarettes

No excise tax increase at the Federal level 43 states and the District of Columbia have

increased cigarette taxes since January 1, 2002

The current average state cigarette excise tax is $1.02 per pack – more than double the rate at the beginning of 2002 (43.4 cents).

27Source: RTI Data

State Level Cigarette Excise Tax Rates, February, 2003

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State Level Cigarette Excise Tax Rates, March 2007

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Department of Justice Lawsuit

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Dept of Justice Lawsuit

September 22, 1999: U.S. Department of Justice filed a civil RICO lawsuit to hold the tobacco companies legally accountable for decades of illegal and harmful practices

September 21, 2004: Trial begins

June 9, 2005: Trial ends

August 17, 2006: Judge Kessler issues ruling• Finds tobacco companies liable• Is constrained in remedies due to earlier appellate court

ruling requiring that all penalties be “forward-looking”

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Key Aspects of Ruling

Prohibits the tobacco companies from committing acts of racketeering in the future or making false, misleading or deceptive statements concerning cigarettes and their health risks

Bans terms including "low tar," "light," "ultra light," "mild," and "natural" that have been used to mislead consumers about the health risks of smoking and prohibit the tobacco companies from conveying any explicit or implicit health message for any cigarette brand

Requires the tobacco companies to make corrective statements concerning the health risks of smoking and secondhand smoke and their deceptive practices through newspaper and television advertising, their web sites and as part of cigarette packaging

Extends and expands current requirements that the tobacco companies make public their internal documents produced in litigation

Requires the tobacco companies to report marketing data annually to the government

Financial remedies requested by DOJ not implemented due to the appellate court ruling requiring that penalties be “forward-looking”

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Judge Kessler’s Ruling:

1. Defendants have falsely denied, distorted and minimized the significant adverse health consequences of smoking for decades.

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Judge Kessler’s Ruling:

2. “Every aspect of a cigarette is precisely tailored to ensure that a cigarette smoker can pick up virtually any cigarette on the market and obtain an addictive dose of nicotine.”

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Judge Kessler’s Ruling:

3. “Defendants extensively – and successfully – marketed and promoted their low tar/light cigarettes as less harmful alternatives to full-flavor cigarettes, although they knew for decades that there is no clear health benefit from smoking low tar/low nicotine cigarettes.”

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Judge Kessler’s Ruling:

4. The defendants “suppressed, concealed, and terminated scientific research; they destroyed documents including specific reports and studies;…”

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by G.B. Trudeau (Page 1 of 2)

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by G.B. Trudeau (Page 2 of 2)

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www.ctri.wisc.edu