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- Tobacco easily accessible • Benefit Calculus Smoking in public legal • Unfettered advertising • Poor access to cessation help • Cigarettes designed to addict • New flavored products • Individual youth use; lead to addiction 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%

Standard-of-Care OR and RR Abstinence Rate (strong data) Eff ffica cacy OR = 2.88 24% Varenicline RR = 2.43 Rates Combination NRT: OR = 2.73 23% Nicotine Patch + RR = 2.33 Gum, Lozenge (Immediate Release) OR and RR Abstinence Rate (strong data) Mono-therapy OR = 1.91 18% Nicotine Patch RR = 1.75 OR = 1.68 16% Nicotine Gum RR = 1.59 OR = 1.68 16% Nicotine Lozenge RR = 1.59 OR = 2.02 18% Nicotine Inhaler RR = 1.82 OR = 2.16 Nicotine Nasal Spray 19% RR = 1.93 OR = 1.85 Bupropion 17% RR = 1.71 OR = 1.85 Cochrane Review: Nortriptyline 17% RR = 1.71 Cahill 2013 Clonidine OR = 1.89 17% RR = 1 74

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?

• 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 Spanish Speaking • English, Spanish and interpretation service 1 - 855-Dejelo-Ya • 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% of 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

Promoting Quitting/Increasing Reach 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 othe her dr drug ug us use disorder ers a and/or m mental h health trea eatmen ent

Promoting Standard of Care Tobacco Treatment Our questions Wha hat pe percentage of pr primary c care ph physicia ians ns k kno now o of 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 of 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 of 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?

Increasing Successful Quitting Our questions Does es u use of i ineffec ective m e met ethods d decrea ease e quit a t attempts ts o over 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 ethods? When d do unsuccessful q l quit met 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 otate “ “Why Qu y Quit it” w with “ “How to Qu Quit it” mes essages i improve q quit r t rates? How c Ho can w we i e increase s successfu ful quitti ting i in each o of t the most v vulner erable p e populati tions?

Increasing Successful Quitting/Special Populations 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.

Help elp u us Change th the C Cos ost-Benefit C Calculus! Thank y k you! Tobacco more expensive and • less accessible Smoke-free policies • Counter-marketing and • Individual promotion restrictions Easy access to tobacco • treatment Cigarettes made less addictive • New products regulated • Tobacco Addiction Society