NIH State-of-the-Science Conference Statement on Tobacco Use

NIH State-of-the-Science Conference Statement on Tobacco Use

Pebbles Fagan, PhD, MPHHealth ScientistTobacco Control Research BranchBehavioral Research ProgramDivision of Cancer Control and Population SciencesNational Cancer Institute

CosumerDemandInnovations in Building Consumer Demand for Tobacco Cessation Products and ServicesWashington, DC May 3-4, 2007

Background on SOS

• Meeting held June 12-14, 2006 and directed by Office of Medical Applications in the NIH OD.

• Goal- to provide providers, patients, and the public with an assessment of the data on tobacco use prevention, cessation and control.

• Summary statements prepared by a 14 member independent panel and based on results of systematic reviews, presentations, and meeting questions and statements.

• The independent report is not a policy statement of NIH or the government.

• http://consensus.nih.gov/2006/2006TobaccoSOS029html.htm

Main Questions of SOS

• What are the effective population and community-based interventions to prevent tobacco use in adolescents and young adults, including among diverse populations?

• What are the effective strategies for increasing the implementation of proven, population-level, tobacco-use cessation strategies, particularly by health care systems and communities?

• What is the effect of smokeless tobacco product marketing and use on population harm from tobacco use?

Main Questions of SOS

• What is the effectiveness of prevention and cessation interventions in populations with co-occurring morbidities and risk behaviors?

• What research is needed to make the most progress and greatest public health gains nationally and internationally?

• What are the effective strategies for increasing consumer demand for and use of proven individually oriented cessation treatments, including among diverse populations?

Key Recommendations

• What We Know– Mass media education campaigns with brief recurring messages help

motivate smokers to quit. This is effective when combined with other interventions such as telephone based counseling or support services.

– Proactive telephone smoking cessation support occurs when providers initiate contact with the smoker.

– Advice to quit is effective, especially when combined with educational approaches or pharmacological therapies.

– Increasing the unit price for tobacco products increases tobacco use cessation and reduces consumption regardless of the smoker’s ethnicity, gender, and SES status.

Key Recommendations

What We Know– Reducing out-of-pocket costs for effective cessation therapies increases

use (i.e. insurance pays for costs).

– Making smokers aware of health insurance coverage policy can increase use of smoking cessation treatments.

– Culturally tailored, gender-specific, and language appropriate programs show promise.

– Community-based interventions aim to increase demand for cessation interventions (media campaigns, higher prices, smoke-free environments) or facilitate access to cessation services.

– Strategies that institutionalize cessation services in health settings (i.e. brief counseling) increase use of cessation services.

Key Recommendations

What We Need to Learn• Understand how to best tailor to specific populations.

• Learn how to make treatments more attractive to tobacco users and create sustained demand for such treatments.

• Understand the role of different media in increasing consumer demand for and use of effective, individually-oriented tobacco cessation treatments for diverse populations.

• Identify and reduce barriers faced by providers, insurers, policy makers, and others to implementing effective strategies to increase and sustain demand for smoking cessation treatment.

• Examine the effectiveness of components of telephone-based counseling programs (e.g. population quit lines vs. provider programs).

Key Recommendations

What We Need to Learn• Develop and enhance pharmacological and non-pharmacological treatments.

• Evaluate the effectiveness of public performance measures and financial incentives for increasing smoking cessation.

• Increase policymakers’ and public’s awareness of effective strategies for preventing tobacco use. Promoting tobacco cessation, and decreasing harm from ETS.

• Identify and overcome barriers to implementing successful comprehensive statement tobacco control programs, such as those used in California and Florida.

• Develop effective policies for reimbursing health providers for offering tobacco cessation.

Key Recommendations

What We Need to Learn• Determine the effectives of incorporating context in interventions to prevent or

stop tobacco.

• Evaluate approaches to reduce tobacco use in populations that are particularly vulnerable or where tobacco has a disproportionately adverse effect – persons with co-occurring conditions, racial/ethnic minorities, low SES, limited English proficiency, low literacy, LGBT.

• Learn from natural experiences that result from the implementation of new policies.

• Evaluate effectiveness of chronic care models for increasing cessation.

• Educate providers and allied health professionals about the importance of tobacco-related diseases and availability and delivery of effectiveness interventions.

Summary

• Many recommendations are consistent with PHS guidelines and previous recommendations.

• Recommendations clearly define role of individual, community and health systems change to increase demand.

• There is a need for more effective products (i.e. pharmacotherapy).

• We have little documentation of consumer experience with cessation services.

Key PlayersProviders

Marketing

Media

Policies/Policy makers

Insurers

Researchers

Consumers

Health and Educational Institutions

Funding Announcements

• Small Grants Program for Behavioral Research in Cancer Control (R03) PAR-06-458 Expires December 23, 2008.

• Social and Cultural Dimensions of Health, Trans-NIH Program Announcement (R01) - PA-05-029 - Expires January 3, 2008.

• Exploratory Grants for Behavioral Research in Cancer Control (R21)- PA-06-351 - Expires May 2, 2009.

• Methodology and Measurement in the Behavioral and Social Sciences - PA-05-090 - Expires May 2, 2008.

Funding Announcements

• Information Technologies and the Internet in Health Services and Intervention Delivery – Trans-NIH program announcements. Expires May 9, 2009http://grants2.nih.gov/grants/guide/pa-files/PA-06-224.html (R21) http://grants.nih.gov/grants/guide/pa-files/PA-06-225.html (R03)http://grants.nih.gov/grants/guide/pa-files/PA-06-226.html (R01)

• Understanding and Promoting Health Literacy, Trans-NIH Program

Announcements - PAR-07-020 for R01s and PAR-04-117 for R03s. Expires Jan 26, 2010.

• Testing Tobacco Products Promoted to Reduce Harm, PA-04-103 (R01s)and PA-06-361 (R21s). Expires March 6, 2009.

• SBIR - http://dccps.nci.nih.gov/hcirb/sbir/

Dissemination Research

• Dissemination and Implementation Research in Health (R01),PAR-07-086. Expires September 2, 2009.

• Dissemination and Implementation Research in Health (R03), PAR-06-520. Expires October 2, 2009.

• Dissemination and Implementation Research in Health (R21), PAR-06-521. Expires October 2, 2009.