Tobacco Cessation: What we need to know to move forward Sally - - PowerPoint PPT Presentation

Tobacco Cessation: What we need to know to move forward

Sally Herndon and Joyce Swetlick, Tobacco Prevention & Control Branch, NC Public Health, DHHS

Our Uphill Battle: Changing the Cost- Benefit Calculus

• Tobacco easily accessible
• Smoking in public legal
• Unfettered advertising
• Poor access to cessation help
• Cigarettes designed to addict
• New flavored products

youth use; lead to addiction

Individual

Tobacco Addiction

Society

We Know What works! Yet there are so many barriers

Treating Tobacco Use and Dependence: Clinical Practice Guideline 2008 Update:

• Abstinence rates:
• Quitting cold turkey, no counseling or medication: <5%
• Screening for tobacco use: ~6%
• Brief advice from physician: 10%
• Low intensity Counseling alone: 16%
• Medication alone: 23%
• Medication + Quitline counseling: 28%
• Intensive counseling + medication: ~32%

Eff ffica cacy Rates

Standard-of-Care OR and RR Abstinence Rate (strong data) Varenicline

OR = 2.88 RR = 2.43 24%

Combination NRT: Nicotine Patch + Gum, Lozenge (Immediate Release)

OR = 2.73 RR = 2.33 23%

Mono-therapy

OR and RR Abstinence Rate (strong data)

Nicotine Patch

OR = 1.91 RR = 1.75 18%

Nicotine Gum

OR = 1.68 RR = 1.59 16%

Nicotine Lozenge

OR = 1.68 RR = 1.59 16%

Nicotine Inhaler

OR = 2.02 RR = 1.82 18%

Nicotine Nasal Spray

OR = 2.16 RR = 1.93 19%

Bupropion

OR = 1.85 RR = 1.71 17%

Nortriptyline

OR = 1.85 RR = 1.71 17%

Clonidine

OR = 1.89 RR = 1 74 17% Cochrane Review: Cahill 2013

CDC DC A Aut uthor Dr

• Dr. R

Ralph ph Caraballo’s C Commen ents/ My Q y Questions

Most smokers who tried to quit cigarettes used a combination of methods (12417) in their last quit attempt compared to those who reported using only one method (3526). Most are not using the most effective combination – Counseling plus Varenicline or Combination NRT – What can we do to change that? For those who only tried using one method of quitting most do not use FDA approved medication. What can we do to change that?

Spanish Speaking 1-855-Dejelo-Ya

• An evidence-based telephone tobacco treatment service
• Recommended for tobacco users ready to quit
• Consists of four treatment sessions
• Special 10 treatment sessions and protocol for pregnant

women;

• Coming soon: Behavioral Health Protocol
• Highly trained, professional Quit Coaches
• Available free to all North Carolina residents, based on

availability of funds

• Comprehensive services available at reasonable rates
• Accessible 24 hours a day, 7 days a week
• English, Spanish and interpretation service
• Integrated with an interactive web-based tobacco treatment

program

QuitlineNC - Funding limitations

• QuitlineNC funding allows for only about 1% of

the NC population that uses tobacco to have services.

• CDC recommends funding Quitlines to serve 7%
• f the population that use tobacco.
• QuitlineNC funding only allows Medicaid and

Uninsured to get standard of care treatment:

• 4 calls plus
• 12 weeks combination NRT

Unless the Payer can pay for these services.

NY State is finding best results come from campaigns that promote standard of care - Both physicians and patients benefit

2019: Year of Cessation CDC DC

New Surgeon General’s Report CDC’s priority areas:  Increase quit attempts among people who use tobacco products  Increase the use of evidence- based cessation interventions  Increase reach of evidence- based cessation interventions

Our questions:

Besides a a 10%+ i inc ncrease i in n toba bacco tax, x, wha hat pr price inc ncentives w work be best t to i inc ncrease qui quit a attempts? e.g. How s suc uccessful are “ “carrots and s nd sticks” ( (e.g., pr premiu ium di differentia ials) appr pproach t h to toba bacco us users i in n attempting ng and s nd suc ucceeding in l n long ng-term a abs bstine nenc nce? How can n we be best r reach e h each g h group o p of vul ulne nerable le po popula pulatio ions w with c h cul ulturally lly spe pecif ific a and nd appr ppropriate messages t to i inc ncrease suc uccessful qui l quitting? How c can T n Telehealt lth h and nd Qui uitlin ineNC he help r p reach r rural and nd unde underserved po d popul pulations? What w wil ill l work to more full lly e engage b behavioral l health p provide ders t to offer standa dard d of care t treatment conc ncurrently w with h treatment for o

• the

her dr drug ug us use disorder ers a and/or m mental h health trea eatmen ent

Promoting Quitting/Increasing Reach

Our questions

Wha hat pe percentage of pr primary c care ph physicia ians ns k kno now o

• f a

and nd pr practice s standa ndard o d of care t toba bacco t treatment? Wha hat clini nical pr practic ices are t the he m most i important t to r reach h with h training for t toba bacco treatment i in n orde der t to s sus ustain in he health s h systems cha hang nge a across N NC? How can we e red educe d e disparity o

• f those w

who r rec eceive assistanc nce f for t tobacco depende denc nce by by provide ders? What wil ill l it it take t to i incorporate standard of c care tobacco treatment into a all electronic nic he health records ds?

What i is t the e effectivene ness o

• f Opt

pt Out vs vs Opt pt In referr rrals t to quit p programs ( (e. e.g, Q Quitline nes, h hospi pital and c d commun unity p programs) on quit attempts, l long ng- term abs bstinenc nce and p d patient s satisfaction? n?

Promoting Standard of Care Tobacco Treatment

Our questions

Does es u use of i ineffec ective m e met ethods d decrea ease e quit a t attempts ts o

• ver t

time, a and i if so, wh what d do we n e need eed t to do t to s stop t the e use o e of ineffecti tive met ethods? When d

do unsuccessful q l quit atte temp mpts ma made b by to tobacco u users b beco come a detri riment t to tryi ying a again, if at all?

Do m media c campaign gns that r run y year r round and r rot

• tate “

“Why Qu y Quit it” w with “ “How to Qu Quit it” mes essages i improve q quit r t rates? Ho How c can w we i e increase s successfu ful quitti ting i in each o

• f t

the most v vulner erable p e populati tions? Increasing Successful Quitting

Our questions

How d do w we e assist e e-cig igarette us users to qui quit? Dua ual user ers? How do does ni nicotine salts affect t the he up uptake of ni nicotin ine? Sho hould da daily a ado dolescent t toba bacco us users be be offered d Standa dard d of C Care couns unseli ling and nd medi dicatio ions? Wha hat is the he i ide deal dur duratio ion a and nd spa pacing ing of t toba bacco treatment c coun unseli ling f for l long ng-ter erm a abstinen ence? e? Ide deal dur duratio ion of m medi dicatio ion? n? Wha hat are e effective c coun unseli ling a and nd medi dicatio ion n interventio ions ns f for t the he lighter toba bacco us user w who ho smokes es les ess t than 10 cigarettes es p per er d day a an/or for the e inter ermittent tobacco u user er? C Cigar smokers, f for example.

Increasing Successful Quitting/Special Populations

Individual

Tobacco Addiction

Society

• Tobacco more expensive and

less accessible

• Smoke-free policies
• Counter-marketing and

promotion restrictions

• Easy access to tobacco

treatment

• Cigarettes made less addictive
• New products regulated

Help elp u us Change th the C Cos

• st-Benefit C

Calculus! Thank y k you!