CESSATION ACTIVITIES IN THE UNITED STATES

California and Massachusetts have developed comprehensive programs that include media campaigns, community interventions, and state-sponsored telephone quit lines. These programs have been successful in increasing smoking cessation. Oregon has collaborated with managed care organizations to improve treatment and also provides telephone counseling and medication to Medicaid clients. Florida has developed a very successful media campaign and community intervention that reduced smoking by young people.

Comprehensive programs directed at both young people and adults that focus on decreasing initiation, increasing cessation, and decreasing exposure to ETS have proven effective. In California, comprehensive tobacco-control programs and policies have been associated with accelerated declines in cardiovascular disease and deaths from lung cancer compared to the rest of the nation.

State Roles. The Center for Disease Control and Prevention’s 1999 Best Practices for Comprehensive Tobacco Control Programs suggests that comprehensive state programs include the following (1999):

 
• Community programs to reduce tobacco use.
 
• Chronic disease programs to reduce the burden of tobacco related disease.
 
• School programs to reduce tobacco use by young people.
 
• Enforcement of clean indoor air and minors’ access laws.
 
• Statewide programs.
 
• Counter-marketing campaigns.
 
• Cessation programs.
 
• Surveillance and evaluation.
 
• Administration and management.

Combining individual, systems, and population-based approaches that increase cessation offers the best opportunity to reduce morbidity and mortality from tobacco use, which is the leading preventable cause of death in the United States. The clinician’s role is to assess every patient’s tobacco use and interest in quitting, advise those who smoke to stop, offer individual, group, or telephone counseling, and encourage patients to use effective medications. The role of the health care system is to implement system changes to support routine tobacco treatment by clinicians and to monitor the effect of treatment through quality performance measures.

Employers also play a role, which consists of providing insurance coverage for cessation services, providing treatment services at the worksite, and establishing smoke-free buildings or campuses. Finally the role of the government is to increase the price of tobacco products, implement media campaigns, enact clean indoor air policies and laws, regulate tobacco products, and ensure insurance coverage of tobacco use treatment.

CORINNE G. HUSTEN
ABBY C. ROSENTHAL
MICAH H. MILTON

References

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Author Info: CORINNE G. HUSTEN, ABBY C. ROSENTHAL, MICAH H. MILTON, The Gale Group Inc., Macmillan Reference USA, New York, Gale Encyclopedia of Public Health, 2002