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Go West, Young (Smoking) Man

Best plans for quitting smoking: Oregon

THURSDAY, Nov. 15, 2001 (HealthDayNews) -- If you want to make today's Great American Smokeout the first day of the rest of your life without cigarettes, look westward for help. If you're poor and want to quit, Oregon's the place to go.

A new survey released this month by the Centers for Disease Control and Prevention (CDC) finds 33 states and the District of Columbia provide medical coverage for at least some treatments to help people kick their tobacco habits.

But only Oregon's Medicaid program offers the full pack of smoking cessation therapies, from drugs, gum and patches to counseling and telephone help lines, as recommended by the Public Health Service. Seventeen states don't yet provide any cessation coverage through Medicaid.

The number of Medicaid programs that do cover smoking cessation rose 35 percent between 1998 and 2000, the survey finds. Thomas Glynn, director of cancer science and trends for the American Cancer Society, says the increase is encouraging, especially since cessation interventions only recently have been proven effective. "We're on a roll, and the states are getting the idea that this is a cost-effective way of offering another valuable treatment in Medicaid," Glynn says.

On the other hand, Glynn says there's much room for improvement. "Oregon is really the only [state] where you have the best shot at being a successful quitter. [There] you can try what works best for you."

Medicaid, the government's health insurance program for low-income people, had about 32 million beneficiaries last year. Of those, 11.5 million adults, or 36 percent, smoked, compared with about 24 percent in the general population. Health officials want to cut the rate of adult smoking in half by the year 2010.

"I'm encouraged by the fact that nine states went from providing no coverage [in 1998] to providing some coverage" last year, says survey co-author Dr. Corinne Husten, a CDC tobacco expert. But to meet the 2010 goal, "clearly there need to be improvements in the extent of the coverage."

Smoking and other tobacco use kill an estimated 430,000 Americans each year, while racking up $50 billion in direct medical expenses, experts say.

Experts say smoking cessation efforts are excellent investments for Medicaid, especially those that target heart patients and pregnant women who risk delivering premature, underweight babies by using tobacco. Every dollar spent to help pregnant women quit saves $3 to $6 of Medicaid money in the same year, says Helen Schauffler, a tobacco control expert at the University of California at Berkeley and co-author of the CDC study.

"If we're going to try to reduce low birth-weight babies and poor birth outcomes, this is the best place to start," says Schauffler. Two of every three pregnant smokers are covered by Medicaid programs, she says.

But while smoking is particularly harmful for pregnant women, Medicaid programs in only 13 states provided counseling to reduce tobacco addiction in this group. Neither drugs like GlaxoSmithKline's Zyban and its sister pill Wellbutrin (the brand names for bupropion) nor nicotine supplements have been proven safe for pregnant women, Schauffler says. States that aren't paying for counseling to help these women quit smoking "need to look at the evidence and begin to provide these benefits," she says.

The rest of the nation's Medicaid programs offer a patchwork of cessation benefits.

Of the 34 Medicaid programs that did cover tobacco cessation treatments, 31 paid for at least some prescription drug therapy, such as Zyban, to help smokers quit. That's an increase of 35 percent from 1998, when 23 states provided such coverage. A smaller share of states covered non-prescription drugs to reduce nicotine craving.

Sixteen of the 34 programs reported covering all recommended drug treatments, including prescription pills and over-the-counter products like nicotine gums, patches and inhalers. Medicaid programs in 11 states offered either drug treatments or counseling, and two programs paid for counseling but not drugs.

A recent study of smoking cessation therapies showed that counseling was among the most effective methods and one of the least utilized, says Linda Bailey, director of the American Cancer Society's center for tobacco cessation policy and evaluation in Washington, D.C. "It has a tremendous payoff not only in reduced morbidity and mortality but really in improved quality of life."

What To Do

Today the American Cancer Society is sponsoring the Great American Smokeout to encourage people to quit for at least 24 hours.

QuitNet and EndSmoking have more on smoking cessation programs.

For information about the habit's harmful effects, check the CDC.

SOURCES: Interviews with Corinne Husten, M.D., M.P.H., medical officer, CDC, Atlanta; Helen Schauffler, Ph.D., professor of health policy, director, center for health and public policy studies, University of California at Berkeley; Thomas Glynn, Ph.D., director, cancer science and trends, American Cancer Society; Linda Bailey, J.D., director of the American Cancer Society's center for tobacco cessation policy and evaluation, Washington, D.C.; Nov. 9, 2001, CDC Morbidity and Mortality Weekly Report
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