Janice Milliman, Quit Coach, Service Delivery:

Scare tactics generally don't work for changing behavior, at least not for long. So I'm not convinced that putting up graphic pictures of diseased organs is an effective anti-smoking campaign.

New York and Massachusetts were the first to institute this new tactic, designed to deter kids from picking up the habit. The New York City Health Department states, "Point-of-purchase warnings are one of the best tools we have to keep the next generation of New Yorkers from becoming addicted. By trying to suppress this educational campaign, the tobacco industry is signaling its desire to keep kids in the dark." Additional support for the ads comes from Eric Lindblom, with the Campaign for Tobacco-Free Kids in Washington. "To have something there to remind them how horrible, how addictive this is, to tell them how to get help, we think it will be a very, very powerful tool for counteracting the power of tobacco advertising at the retail outlet."

The ads I've seen are quite graphic, impersonal, and ugly, to say the least. I know my kids, age 7 and 10, would find them alarming. Teenagers will say they're "totally gross," but usually are more motivated to quit when they learn smoking causes wrinkles. Is this really the best way to motivate kids to quit, or better yet, never start? Maybe not. The ads I've seen don't show or describe how addictive smoking or nicotine is. While most people have heard gory details of smoking's effects, many don't know how physically addictive nicotine is when inhaled through a cigarette.

I can't help but draw some correlation to other ad campaigns involving healthy behaviors. Take a look at the got milk? commercials and ads. Do they depict an older osteoporotic and bent over woman who didn't drink enough milk? No. Do they show what your bones look like with osteoporosis? No. When we're young, we don't think those things will ever happen to us. That type of advertising just doesn't work on kids.

The got milk? ads encourage kids to drink milk by showing celebrities--positive role models--with a milk 'stash. My daughter would be more impressed with a poster of Justin Bieber and the healthy lungs he has, than a poster of the black lungs of some nameless person.

Carly Palady, Quit Coach, Service Delivery:

It was 5 o' clock in the morning as I settled in to start the day with a hot decaf mocha, and my computer purring along in anticipation of the calls to come. In the back of my mind, I knew that like every other day this week, I would be building more Quit Plans for the residents of Washington State, who experienced a $1.00 tax increase on tobacco on May 1, 2010. This puts some cigarette packs at over $7.00. For a pack a day smoker, this would equal over $200 a month; a hefty sum for a month of cigarettes.

Still, for many Washington State residents, the financial benefits are not the common taxation concerns that I am hearing. Rather, with the economy in a slow state, many are asking: 

1. "We're in a recession- if we tax tobacco, and nobody can afford it, then what do we really gain from the higher tax?"

2. "Washington already charges over $3.00 a pack in taxes- why punish us? I pay my taxes, and I work. I shouldn't have to have this freedom taken away."

Both of these general statements I have been hearing from callers are valid: What do we gain from a higher tax, if more people quit because of this taxation? Are we taking away a freedom of choice, if financial reasons alone lead a person to quit tobacco?

What does this $1.00 taxation bring to those of us who live in Washington State?

According to the Washington State Department of Revenue, this means more funds for:

1. Healthcare Funding (Medicaid, Medicare, etc.)

2. K-12 Education (Including more education on tobacco cessation and Illness Prevention)

3. Drug Enforcement (including Tobacco Cessation Programs, such as the Washington State Quit Line)

4. Salmon Recovery: Commercial Fishing brings in over $38 Million in Economic Revenue in the state (According to the Washington State Department of Fish and Wildlife)

If we take a snapshot of Washington State from a health and taxation perspective in regards to number one on this list, Healthcare Funding, we see the largest personal and economical impact with Medicaid. Medicaid is one of the programs most impacted by tobacco and supported by taxpayers in Washington State. Medicaid's deficit budget in Washington State is more than 5 million dollars annually. While the state is making cuts to save money during this recession, according to USA Today, enrollments have increased 5.8% in 2009, from 2008. USA Today also shows that federally, Medicaid enrollments have increased 5.8%, despite the national deficit. 21% of a state budget is allocated to Medicaid- roughly the same as education. This means, that both on the State and Federal level, more people are seeking Medicaid assistance, while there are less funds to cover new enrollments. Ironically, Medicaid members (which include seniors in nursing homes, people with disabilities and chronic illness [such as COPD/Emphysema], pregnant women, and low-income children and adults), use tobacco 53% more than the average population (Centers for Disease Control and Prevention). With enrollments increasing, and the majority of this population using tobacco, more taxpayer money will be used to close the deficit, and treat preventable illnesses caused by tobacco use.

So, because over half of the Medicaid population uses tobacco, a larger percentage of taxpayer funds are going towards the treatment of COPD, Emphysema, lung cancer, chronic bronchitis, asthma, and other smoking-related illnesses that Medicaid members are granted benefits for, or are diagnosed with, while they are in the program. In the future, more people quitting, especially Medicaid members, means a lower state deficit, and less taxpayer money being used for the treatment of preventable chronic conditions. If less people have chronic conditions, then less are going to have to seek state and federal coverage like Medicaid to pay for these treatment costs. Overall, for those who smoke now, quitting means a lower chance of them having to deal with a smoking-related illness, and in turn having to use Medicaid for a tobacco-related illness in the future.

Finally, increasing tobacco taxes to pay for the prevention of tobacco use, and the cessation for those that use it, gives freedom to Washington State citizens. With taxes likely to continue to increase on tobacco products in the future, those who quit now who are in general good health, save more money exponentially, and they have a lower likelihood of needing Medicaid in the future. These illnesses take away working years of their lives, a chance to save more for retirement, and spend time with family. Quitting tobacco gives people financial freedom, personal health and mobility, more time with family, and the joy of not having their daily routine dictated by an addiction.

Lori Huskey, Quit Coach, Service Delivery:

It was 6pm at the Las Vegas Luxor casino and my friends and I were seated at the hotel restaurant for dinner. A couple at the opposite table sat chatting idly and the man lit a cigarette with his Luxor Casino matches. Although the restaurants and lounges all spilled into the open air casino, a waiter came over and promptly told the man to put out his cigarette. As it turns out, there are non-smoking areas in Las Vegas casinos—who knew? But don’t get to excited just yet. Just because hotels ban smoking in non-casino areas doesn’t mean they’re aiming to prohibit smoking altogether. Why? It would just be too much of a gamble to lose the customers who have their cards in one hand and a cigarette in the other. In fact, Jeff Siri, who has even suffered from secondhand smoke agrees: “It would be an economic disaster if smoking were banned in Nevada casinos," he remarked. "When people are gambling, it is amazing how many of them smoke."

Just last month a former casino worker Cheryl Rose died of lung cancer. Rose was an avid supporter of the smoking ban and could be found protesting the law with signs that said “What happens in a casino stays in your lungs”  and hers is a story we hope will stay in the minds of Nevada state lawmakers.  On a more positive note, other states are taking steps forward. Louisiana has now banned smoking in bars and casinos despite its fear of “reducing customers at casinos” as they bill would “trigger layoffs and mean less tax revenue for the state.” Michigan has taken laudable steps to better the health of their state citizens as the 38th state that banned smoking in public places last Saturday.

When smoking is so distinctly linked to revenue, jobs, and attracting a large population that lights up it’s hard to know whether or not such a law will benefit the economy. The casino worker Cheryl Rose was described as a robustly fit woman who enjoyed the outdoors. It’s her decision to get outside and stay active just as a tobacco user decides to smoke a cigarette in their home. But when businesses fall into the picture they are the ones held accountable for the fate of others. Yes, that means losing customers if your business goes smoke free. But the bigger picture we’re looking at here isn’t just financial health but personal health and the pleasure adults feel from being mobile and active just might outweigh anything else.

Jacqueline Glass, Quit Coach, Service Delivery:

Michigan joins the ever growing list of states that ban smoking in public places this Saturday, May 1. Michigan is the 38th state to ban public smoking, which leaves only 12 states left that permit smoking in public places. The legislature has passed the smoking ban exempting casinos, cigar bars, home office, and motor vehicles. Michigan’s law bans smoking in all other workplaces including all bars and restaurants. Individuals who violate the smoking ban will receive a $100 fine for their first offense. Management is required to enforce that ban.

As with any smoking ban, reactions are mixed. The biggest concern for most business owners in Michigan is will they lose money due to this ban; yet studies in other smoke-free states have found no significant decrease in restaurant and bar sales when a smoking ban is enforced.

Many health advocates and others are relieved that this smoking ban has finally passed. It’s been a long time coming - a version of the smoking ban legislation has been rejected or ignored in Michigan multiple times.

With Michigan going smoke free, it looks like the Michigan State Quit line will be busy this spring. We’re ready and waiting to take those calls.

As a family physician dedicated to helping people quit tobacco, I am deeply concerned about the 35% cut to state tobacco programs in the current Washington Senate budget bill. Last year, the state tobacco program was cut 43%, far deeper than most other programs. This year’s original proposal for a $1.00/pack tax increase devoted 20% of the tax revenue to the State Tobacco Prevention and Control fund. However, that provision was removed.  Amazingly, our state Senate bill goes much further downhill by including a 37% cut in tobacco program funding.

Sure, a tax hike will keep some kids from starting to smoke, and cause some adults to quit. But most won’t be able to quit unassisted, even though they want to. It is unethical and immoral to increase the tax on addicted tobacco users with one hand, while with the other hand further dramatically decreasing already-depleted Tobacco Prevention and Control services. The House bill does not cut tobacco program funding. As the bills are reconciled, the House version should be incorporated. If not, it looks suspiciously like our state government is cutting effective services to decrease tobacco use because continuing to fund these services would cut tax revenue.

With only two days left in the state legislative session, you have the chance to help if you act now. Help us let the legislature know that the House plan needs to be incorporated into the final bill presented to the Governor.

Click here to send a message to your legislators.

The slight increase in smoking prevalence detected by the National Health Interview Survey is cause for concern but probably not alarm. The upward trend was small (less than 1%) but it should definitely give us pause. Smoking prevalence has reduced over the years due to a number of factors. The increasing cost of smoking from excise taxes and price increases, as well as smoke-free indoor air restrictions, have both led to reductions in smoking prevalence. As smoking becomes more expensive and less convenient, smokers try to quit. Some smokers quit on their own, but others need help.

Certainly tobacco dependence treatment resources have been a valuable resource for those unable to quit on their own. However treatment programs such as State Tobacco Telephone Quit Lines and face-to-face programs have been underfunded for years. In 1998 there was hope that the money from the Master Settlement Agreement fund (over $300 Billion) would provide the necessary help for smokers to quit this deadly addiction. Sadly, less than 3% of these monies were used to fund tobacco prevention and cessation. As a result no state is offering services they feel are needed to adequately address the treatment needs of smokers, but rather they are offering the services they can based on the inadequate funding they receive. It is a rather sad commentary on how Federal and State governments have addressed the leading cause of preventable death in the US.

This problem has been further exacerbated by the fact that no revenue from the recent $0.62 federal excise tax increase went to fund help for smokers wants to quit. Together these failures to fund treatment and prevention have resulted in less reduction in smoking than was hoped.

Certainly these are tough times. We are in the middle of a severe financial downturn with the feds and states all struggling to keep their heads above water. Nevertheless, many of us in the tobacco-dependence treatment field strongly feel that it is unethical – that it is even a human rights issue – that smokers are taxed on their addiction but none of that revenue is then used to help them become smoke free. We further run the risk of government becoming “addicted” to this source of revenue and, as a result, become less incented to reduce smoking prevalence.

The Tobacco Control field at the federal, state, private, and volunteer levels is full of individuals who are passionate and fully committed to reducing the death and disease caused by smoking. However, to be successful in this critical work funding is necessary to provide services to help smokers of all ages to quit. In the CDC’s most recent Mortality and Morbidity Weekly Report (Vol 58/No 44) you find the following statement: “Offering and providing effective cessation counseling and treatment are integral to reducing the smoking epidemic….”

One can only hope that this report results in those who hold the purse strings to take another hard look at funding for programs to help smokers quit.

It can be easy to get overwhelmed by the tobacco problem. Tobacco is still the leading cause of preventable death in the U.S. Every day I talk to people suffering from emphysema or heart disease and tobacco is largely to blame. I talk to people whose budgets are drained by the price of their habit and whose families are begging them to quit. Tobacco takes its toll.

But then I take a step back and look at the BIG picture. I think of where our society was, even just 60 or 70 years ago, and I'm struck with the realization that we've come a LONG way. Back in my grandparents' day, Americans' views on smoking were radically different than today. Smoking wasn't just accepted, it was glamorized. Movie stars made smoking seem modern and sexy. Cigarettes were accessible, too. The military gave away cigarettes with food rations to soldiers. Children could buy cigarettes with just a note from a parent and people smoked everywhere, even in the restaurants, the grocery stores, and the offices. Smoking was widely accepted.

With that picture in mind, fast forward to today's culture. While back then, close to half of people smoked, now smokers are the minority at only around 20% of the population. Smoking is banned in many public places, like restaurants. Some employers have banned smoking on company premises, and in some states, it's even illegal to smoke with a child in the car. Things have changed. One of the major reasons people choose to quit is that they feel like society no longer accepts smokers. As a Quit Coach, I always ask participants WHY they want to quit. I often hear statements like, "I feel like an outcast" and "None of my friends smoke."

What's the bottom line? Tobacco is still a big problem. But the way smoking fits into our culture has dramatically changed in recent years, and that is a significant achievement. Tobacco is much less prevalent than it used to be and there is high awareness of the health risks. Where will we be in 50 or 100 years from now? The answer lies with us.

During the current recession, organizations are looking for cost savings wherever they can find them. There is particular pressure on employers’ benefits managers to try to reduce those ever increasing health care costs. There has never been a better time to contain cost increases by implementing a program like Free & Clear’s Quit For Life® Program.

Free & Clear happens to be in the right place at the right time. Our customer base and our sales continue to grow rapidly as organizations recognize what the Centers for Disease Control & Prevention (CDC) has been saying for some time, that “there is no better investment in health care for employers than a comprehensive tobacco cessation program.” Both the CDC and the Robert Wood Johnson Foundation have cited Free & Clear as having a model cessation program.

Why has it taken so long for tobacco cessation to be recognized as an important benefit for companies to promote and provide? Until recently, some employers considered tobacco use to be a personal choice and not an issue for their concern as employers. This perception has been changing due to the large amount of media attention paid to tobacco issues and the growing awareness of not only the health risks but the economic costs to the employer. Still, less than half of all companies have any sort of a tobacco cessation program for their employees, and less than 10% invest in a comprehensive, evidence-based program like Quit For Life.

While tobacco use prevalence in the United States has declined significantly in the past few decades, there are still 45 million smokers who cost their employers an average excess cost of nearly $5,500 per year. Rather than just focusing on broad-based wellness programs for all employees, employers now realize that a evidence-based tobacco cessation program can have a great effect on the 20% of employees who create a disproportionate cost burden, both in terms medical costs and lost productivity.

Some employers prefer to contract for all of their wellness and healthy lifestyles programs from a single source like their health plan provider or EAP. Such organizations typically employ coaches who cover many topics like depression, stress, weight concerns, alcohol, tobacco, and a variety of health issues. They perform very useful coaching services but they are not tobacco cessation experts, and tobacco addiction is a very severe chronic condition.

To be effective in helping people to quit their tobacco addiction, employers need to rely on specialists like the Quit Coaches® available in the Quit For Life Program. Our many clients have acknowledged this expertise and have decided to carve out tobacco cessation from their other programs.

Neglecting that “red-headed stepchild” has historically proved itself as unwise. Tobacco dependence treatment, often referred to as "cessation," is just such a red-headed stepchild.

Simon Chapman, PhD, from the School of Public Health in Sydney, Australia, is attending the World Conference on Tobacco or Health in Mumbai, India, as are nearly 3,000 others who work in Tobacco Control. Consistent with his history of taking controversial stands, he has done so again.

In a recent letter to The Lancet, a British medical journal, Chapman made the outrageous statement that “...unassisted cessation remains the preferred and most successful method used by most ex-smokers.”  His argument is primarily based on the assertion that treatment drains resources away from “more effective” public health efforts to reduce tobacco use prevalence (i.e., cigarette price increases; excise tax increases; smoke-free indoor air).  Chapman further emphasizes his point stating that the “medicalization” of cessation has consistently undermined smokers’ self-efficacy by giving the message that “you need help and are unlikely to succeed alone.”

Chapman is both right and VERY wrong in different aspects of his assertion.  I have long shared the concern that we must not send a message to smokers that they cannot quit without help.  In fact, most smokers do quit that way.  So in this regard Chapman is correct.  A better message is one that says, “Quitting smoking can be hard -- if you need help just ask.”

But where he is wrong he is VERY wrong.  There are many smokers who are unable to quit without assistance.  I believe it is unethical, in fact egregious, that these smokers be ignored and allowed to suffer, even die, as a result of their tobacco dependence.  In this belief I am in very good company.  Furthermore, these are the same smokers who are spending more for cigarettes through price and tax increases.  To not use some of that money to help those unable to help themselves is plain wrong, certainly unethical, and maybe even criminal.

Another fact that Chapman clearly misses is that treatment services, such as tobacco quit lines (which are enormously cost-effective) and in-person individual or group counseling, are vastly under used.  Many smokers are simply unaware that services are available or do not know how incredibly effective they are.

Furthermore, smoking is the leading cause of preventable death in the US.  Many, many smokers have life-threatening chronic illness directly associated with their smoking.  Many of these smokers have tried many times to quit unsuccessfully. To allow them to suffer and die behind their addiction to smoked tobacco is unconscionable.

So instead of undermining cessation efforts Chapman would better serve the overall objective of reducing tobacco use prevalence by not undermining the undisputable evidence that treatment not only works and is highly cost-effective, but is absolutely necessary for those unable to quit on their own. But once you have stuck your foot in your mouth in a major way, people have a hard time understanding what you are saying...

For over 35 years, Paychex has helped millions of business owners with payroll, human resources and benefit outsourcing solutions and is recognized as a top national provider for these services. Part of their ongoing success can be attributed to the investment they make in the health of their employees. Implementing a comprehensive tobacco cessation program has played a major part in their robust wellness initiative.

In Free & Clear’s latest Clear Insights webinar, “Why Carve Out Tobacco Cessation: A Story of Success for Paychex,” Bob Merberg, MS, Wellness Program Manager of Paychex, will share key success factors his organization has identified for the seamless integration of a tobacco cessation program into existing wellness offerings, as well as the outstanding outcomes they have witnessed.

Through Clear Insights, Free & Clear shares best practices and thought leadership in the tobacco cessation and weight management industries using white papers and webinars.

Register now for the free webinar, “Why Carve Out Tobacco Cessation: A Story of Success for Paychex,” held March 4 & March 11, 11:00am-12:00pm PST.