Policy Objective: Support for Cessation Services
Setting: State
Below, you will see a list of goals for this policy objective. Click on the specific goal to read strategies you can use to achieve that goal in this setting.
Quitlines and Other Cessation Services
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Funding stemming from excise taxes and other sources should be allocated to support quitlines and other cessation programs based on the Center for Disease Control and Prevention (CDC) recommendation per state. Currently, the CDC recommends that policymakers fund state cessation interventions at a rate of $4.05 per person with a minimum of $2.53 per person. First priority should be given to funding cessation services for persons not covered by insurance.
Recommended by:
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- CDC– Best Practices for Comprehensive Tobacco Control Programs, 2014- pages 50-51, 75
- CDC– Health Equity in Tobacco Prevention and Control
- National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendation 1
- Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- pages 858, 875
- Surgeon General report– Preventing Tobacco Use Among Youth and Young Adults, 2012- page 812
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention O
For more information:
- AAP Issue Brief– Tobacco Cessation and Treatment Programs
- AAP Issue Brief– Tobacco Control Funding
- American Lung Association– Tobacco Cessation Coverage: Helping Smokers Quit
- American Lung Association– State Funding for Tobacco Prevention & Cessation Programs
- Campaign for Tobacco-Free Kids– Broken Promises to Our Children: 1998 State Tobacco Settlement 17 Years Later
- Institute for Global Tobacco Control– The MPOWER framework and United Nations human rights treaties: An additional argument for the promotion of tobacco control goals
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In establishing tobacco control programs (ie, quitlines and community-based programs), states should consider populations disproportionately affected by tobacco addiction and tobacco-related morbidity and mortality. Programs should ensure that health communications and other materials are culturally relevant and that special outreach efforts target all high-risk populations. Programs modified to reach high-risk populations should be evaluated for effectiveness. Dual tobacco product users should also be included in these messages.
Recommended by:- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- page 50
- CDC– Health Equity in Tobacco Prevention and Control
- National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendation 22
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention O
For more information:
- AAP Julius B Richmond Center– Tobacco Control and Specific Populations
- Institute for Global Tobacco Control– The MPOWER framework and United Nations human rights treaties: An additional argument for the promotion of tobacco control goals
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The 2008 Update of the Public Health Service Clinical Practice Guidelines on treating tobacco use and dependence recommend the following: implement a system of tobacco use screening and documentation; direct tobacco users to quitlines; and provide insurance coverage for cessation treatments. The combination of these actions has been shown to be successful in decreasing tobacco use. Regarding implementing a comprehensive tobacco control program, states should expand and promote services such as quitlines and eliminate cost barriers to the medically underserved and uninsured populations. States should ensure that information about cessation benefits in all insurance plans is easy to find and understand. Benefits should be promoted to plan members and plan clinicians.
Recommended by:
- AAP policy statement– Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- page 42
- National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendation 16
- Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- page 875
- U.S. Department of Health and Human Services– Treating Tobacco Use and Dependence: 2008 Update- Clinical Practice Guidelines- pages 7 and 8
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention O
For more information:
- American Lung Association– Tobacco Cessation Coverage: Helping Smokers Quit
- Smoking Cessation Leadership Center– Tobacco-Free Toolkit for Community Health Facilities
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In order to ensure that high quality cessation treatment is available to all, best practices in tobacco should be routinely shared. By participating in, offering expertise for, assisting in the planning of, or financially contributing to a best practices collaboration event, one can further support tobacco control efforts.
Recommended by:
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- pages 20, 64
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Plans should provide effective tobacco use treatment, all Food and Drug Administration (FDA) approved medications (including both nicotine replacement therapies and non-nicotine medications), and individual, group and telephone counseling. Additionally, treatment programs should use a variety of successful cessation methods and a staged disease management model. Programs should also ensure that health communications and other materials are culturally appropriate and that special outreach efforts target all high-risk populations.
New private health plans are required to cover tobacco cessation treatments with no cost sharing. Plans existing before the enactment of the Affordable Care Act (ACA), however, are granted grandfather status, exempting them from the requirement until the plan makes significant changes to coverage or premiums. Provisions were made in the ACA to expand tobacco cessation coverage. While the ACA currently requires Medicaid and some private plans to provide comprehensive cessation coverage for certain populations, not all smokers have access to such coverage. In October 2010, the ACA required all Medicaid programs to provide pregnant women with a no-cost sharing, comprehensive cessation benefit. Medicaid programs cannot exclude FDA-approved cessation medications from their coverage for all enrollees. States that choose to expand Medicaid eligibility must provide tobacco cessation coverage to newly eligible adults through a benchmark benefits package.
To ensure comprehensive tobacco cessation coverage not addressed by the ACA, states should consider their own remedies. States can mandate all insurers governed by the state, both public and private, to provide easy access to tobacco cessation treatment. Specifically, lawmakers can direct that health plans not charge copayments, require prior authorization, limit benefits by duration or lifetime, require stepped care therapy and require specific combinations of treatment.
Recommended by:
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- pages 44-45
- CDC– Health Equity in Tobacco Prevention and Control
- National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendations 14,16, and 20
- Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- page 875
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention O
For more information:
- AAP Julius B Richmond Center– Solving the Puzzle: A Guide to Pediatric Tobacco Control- Working with Youth and Families
- AAP Julius B Richmond Center– Tobacco Control and Specific Populations
- AAP Issue Brief– Tobacco Cessation and Treatment Programs
- American Lung Association– Tobacco Cessation Coverage: Helping Smokers Quit
- Georgetown University Health Policy Institute– Implementation of tobacco cessation coverage under the Affordable Care Act: Understanding how private health insurance policies cover tobacco cessation treatments
- Institute for Global Tobacco Control– The MPOWER framework and United Nations human rights treaties: An additional argument for the promotion of tobacco control goals
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Cessation programs through the workplace are one option for cessation services that is not as wide-spread as it should be. Encourage states to mandate that all employers offer their employees access to cessation programs in order to help them stop using tobacco products. Another tactic that has proven successful is creating incentives to stop using tobacco products, which encourages employees to maintain tobacco-free lifestyles. Electronic nicotine delivery systems (ENDS, or e-cigarettes), which are not approved by the US Food and Drug Administration as an approved cessation device, should not be recommended to help smokers quit.
Recommended by:
- AAP policy statement– Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- AAP policy statement– Electronic Nicotine Delivery Systems
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- page 44
- CDC– Health Equity in Tobacco Prevention and Control
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention O
For more information:
- AAP Julius B Richmond Center– Solving the Puzzle: A Guide to Pediatric Tobacco Control- Community: Employer Support for Work-Based Smoking Cessation
- AAP Issue Brief– Tobacco Cessation and Treatment Programs
- American Lung Association– Tobacco Cessation Coverage: Helping Smokers Quit
- Institute for Global Tobacco Control– The MPOWER framework and United Nations human rights treaties: An additional argument for the promotion of tobacco control goals
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Because they can be accessed from anywhere, quitlines are an especially valuable cessation resource. Helpful cessation materials may include the state quitline, websites, text-to-quit programs, apps and in-person programs. Local resources, such as a state quitline, or a community organization, may be more sensitive to a specific region or ethnic group than more generalized, national resources. However, both national and local quitline info should be made available in any clinical setting, regardless of discipline.
Recommended by:
- AAP policy statement– Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- pages 47-48
- CDC– Health Equity in Tobacco Prevention and Control
- National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendations 14, 16, 17, and 19
- Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- pages 827, 875
- Surgeon General report– How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease, 2010- page 648
- U.S. Department of Health and Human Services– Treating Tobacco Use and Dependence: 2008 Update- Clinical Practice Guidelines- pages 2, 7-8
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention O
For more information:
- AAP Julius B Richmond Center– Tobacco Control and Specific Populations
- AAP Issue Brief– Tobacco Cessation and Treatment Programs
- Institute for Global Tobacco Control– The MPOWER framework and United Nations human rights treaties: An additional argument for the promotion of tobacco control goals
- North American Quitline Consortium– Find your state’s quitline information
Last Updated
05/03/2021
Source
American Academy of Pediatrics