July 2008

Grant Results

SUMMARY

The Pacific Center on Health and Tobacco was formed in 1999 to assist member states in implementing statewide tobacco cessation guidelines. The guidelines were issued by the Agency for Health Care Policy and Research in 1996 (later revised and published through the United States Public Health Service in 2000).

It is an informal coalition of five western states (Arizona, California, Hawaii, Oregon and Washington) and five national partners, including the Centers for Disease Control and Prevention (CDC) and a number of programs funded by the Robert Wood Johnson Foundation (RWJF).

Key Results

  • Acting essentially as a think tank, the Pacific Center shared information and resources both among participants and with non-member agencies and states, and promoted opportunities for collaborative research.
  • It did so through six workshops and four ad hoc meetings, a Web site with "virtual workspace" for its members to exchange information, three reports on different aspects of tobacco cessation, including its key document, Comprehensive Statewide Tobacco Cessation, and two toolkits to guide health providers, insurers, employers and others involved with the issue.
  • It convened a new group of eight states (Hawaii, New Mexico, New Jersey, New York, Pennsylvania, Ohio, Oklahoma and Wisconsin) to participate in training and technical assistance.
  • It fostered a close and ongoing partnership with the Office on Smoking and Health of the CDC.
  • Its work helped to reinforce the idea that tobacco cessation requires critical policy and health care systems change (e.g., benefit design, quality measurement, provider certification, coverage solutions, system-based reminder systems, the business case for cessation) to assure optimal delivery of effective clinical interventions.

Key Recommendations
According to Comprehensive Statewide Tobacco Cessation, state programs should have four interrelated, evidence-based components:

  • State-funded quitlines, which can help people stop using tobacco through direct telephone counseling, coordinate use of stop-smoking medications and partner with health systems.
  • Cessation services routinely offered in conjunction with health care delivery.
  • Benefit coverage through employers, public insurance programs and other health care purchasers.
  • Community development and tailored population-based approaches to reach disparate populations.

Comprehensive Statewide Tobacco Cessation also suggested that state tobacco cessation programs conduct outreach campaigns using communication strategies to influence public opinion and promote health care policy changes.

Funding
RWJF provided the primary funding for the work of the Pacific Center coalition with two grants totaling $774,865 from March 2001 through June 2004.

 See Grant Detail & Contact Information
 Back to the Table of Contents


THE PROBLEM

Most states have established comprehensive policy-oriented tobacco control programs, but there has been no equally comprehensive policy-oriented approach to tobacco cessation. Five western states, California, Oregon, Washington, Arizona and Hawaii, had state funding to implement tobacco cessation programs in accordance with Agency for Health Care Policy and Research guidelines, but lacked resources and sufficient information about best practices to implement those guidelines.

These states formed the Pacific Center on Health and Tobacco in 1999 (three states, Oregon, California and Hawaii were part of the RWJF SmokeLess States® Program see Grant Results) to combine the collective experiences of its members and build a statewide model for cessation policies and programs.

Acting as a think tank, the Pacific Center sought to assist health plans, providers, purchasers and state agencies to define their respective roles and to collaborate on delivering evidence-based cessation services.

 Back to the Table of Contents


RWJF STRATEGY

RWJF has awarded grants to disseminate the original Public Health Service guidelines, (see Grant Results on ID#s 029389, 030329, 030520, 030375, 030525 and 030254). RWJF also supported its dissemination to organized labor (see Grant Results on ID# 029471). And RWJF has supported other projects around the guidelines:

  • Development of a primary care practitioners' pocket guide (see Grant Results on ID# 029466).
  • A conference and proceedings about the guidelines (see Grant Results on ID# 030465).
  • An evaluation of the implementation of the guide by Allina Medical Clinic (see Grant Results on ID# 030499). This helped inform RWJF's national program Addressing Tobacco in Managed Care (for more information see Grant Results).
  • In conjunction with other organizations, the development of a blueprint for adolescents (see Grant Results on ID#s 037525 and 041053 to form the Youth Tobacco Cessation Collaborative).
  • In conjunction with other organizations, the development of a blueprint for pregnant smokers through RWJF's national program Smoke-Free Families: Innovations to Stop Smoking During and Beyond Pregnancy, working with the National Partnership to Help Pregnant Smokers Quit. See Grant Results and www.smokefreefamilies.org.

RWJF also supported researchers at the State of Oregon Department of Human Resources, Health Division, to evaluate the results of efforts by the Tobacco-Free Coalition of Oregon to implement the Oregon Tobacco Cessation Guidelines in the 14 managed care health plans contracting with the Oregon Health Plan. See Grant Results on ID# 034190.

 Back to the Table of Contents


THE PROJECT

The Pacific Center's goals under the grants were:

  • To assist each member state to implement and evaluate comprehensive, effective statewide tobacco cessation services using the best evidence-based recommendations from the federal government and peer-reviewed literature as the basis for its activities.
  • To synthesize and document information and experience for the benefit of member states and to share information and resources with non-member agencies and states.
  • To promote opportunities for collaborative research.

Each of the five member states was represented in the Pacific Center by a principal investigator and a member of the state health department (Hawaii had no health department member). See Appendix 1 for a list of all members.

During the first RWJF grant (ID# 040106), the Pacific Center established partnerships with five national tobacco control agencies and organizations, including the Centers for Disease Control and Prevention (CCD); the RWJF-funded national program SmokeLess States® (see Grant Results); the Center for Tobacco Cessation (funded by RWJF under grant ID#s 040101 and 048091; see Grant Results on ID#s 041053 and 037525 for funding that led to its establishment); and the National Center for Tobacco-Free Kids® (an RWJF-funded center; see Grant Results on ID# 035929 et al). It brought participants together in a series of meetings and began the process of building a model for statewide smoking cessation programs. During the second grant (ID# 044825), the Pacific Center completed and disseminated a series of reports and toolkits and began to explore strategies for implementing recommendations.

RWJF provided the primary funding for the coalition with two grants totaling almost $775,000 from March 2001 through June 2004. The CDC provided $50,000 for 2003–04 and again in 2004–05, via a contract with the NCI, and Pacific Center members and national partners provided in-kind support. The fiscal agent for the Pacific Center is Oregon Health and Science University in Portland, Ore.

 Back to the Table of Contents


RESULTS

  • The Pacific Center fully staffed its administrative office, established a Web site with "virtual workspace" for its members to exchange information and began to develop a long-term funding plan for sustainability.
  • The work of this grantee helped to reinforce the idea that tobacco cessation requires critical policy and health care systems change (e.g., benefit design, quality measurement, provider certification, coverage solutions, system-based reminder systems, the business case for cessation) to assure optimal delivery of effective clinical interventions. In addition, clean indoor air policies and increased tobacco taxes drive many smokers to quit and to use formal treatment. According to the RWJF program officer and the project director, tobacco cessation had been viewed primarily as a clinical issue prior to the project. The Pacific Center's work helped to place evidence-based cessation strategies in the mainstream of policy-based comprehensive tobacco control, notes Tracy Orleans, Ph.D., senior program officer and senior scientist at RWJF.
  • The Pacific Center held six workshops and four ad hoc meetings. Representatives of the state health departments and other agencies of the coalition states, as well as representatives of the CDC, the Center for Tobacco Cessation and the SmokeLess States National Program Office attended each workshop. The workshops focused on specific topic areas, such as quitlines, health care benefits, cessation during pregnancy and disparities in treatment, while the four ad hoc meetings focused on strategic approaches for implementation. Although the group devoted two workshops to disparities in treating diverse populations, including natives of Alaska and Hawaii, Asian-Pacific Islanders and Hispanics, as well as mentally ill and chemically dependent populations, the only agreement was that the topic required specialized approaches and more discussion. However, the Pacific Center was unable to secure funding to continue this discussion.
  • The Pacific Center staff wrote and distributed three reports, including its key document, Comprehensive Statewide Tobacco Cessation, and two toolkits. The reports, which also include Building a Financial Infrastructure: Health Plan Benefits and Provider Reimbursement and Linking a Network: Integrate Quitlines with Health Care Systems, made evidence-based recommendations that cover reimbursement and quality guidelines and integration of quitlines with health systems. The toolkits were "Health Insurance Benefits for Treatment of Tobacco Dependence," intended to guide discussions of employers and purchasers, and "Invest in Tobacco Cessation for a Healthy Productive Workforce," to give employers an overview of the business case for providing tobacco cessation benefits. All the reports and tools are on the Web site. (See Bibliography for details.)
  • The Pacific Center fostered a close and ongoing partnership with the Office on Smoking and Health of the CDC. That office used the resources created by the Pacific Center to help nonparticipating states with their tobacco cessation programs and to disseminate information and reports developed by the five-state coalition.
  • The director of the Pacific Center co-chaired roundtable discussions of the Center for Tobacco Cessation in 2002 and 2003. Pacific Center members provided expertise in specific topics related to statewide policy-based cessation programming for this organization, which focuses primarily on national initiatives, thus bringing the state and national perspectives together.

Recommendations

  • According to Comprehensive Statewide Tobacco Cessation, state programs should have four interrelated, evidence-based components:
    1. State-funded quitlines, which can help people stop using tobacco through direct telephone counseling, coordinate use of stop-smoking medications and partner with health systems. Quitlines staffed by trained counselors are easily accessible, convenient and provide economies of scale. For more details see another report, Linking a Network: Integrate Quitlines with Health Care System.
    2. Cessation services routinely offered in conjunction with health care delivery. Health professionals should consistently advise tobacco users to quit and assist them in the effort. Providers can refer patients to quitlines and may also be able to seek reimbursement for tobacco cessation services through standard diagnostic and billing codes. For more details see another report, Building a Financial Infrastructure: Health Plan Benefits and Provider Reimbursement.
    3. Benefit coverage through employers, public insurance programs and other health care purchasers. Tobacco users need access to affordable services through the private and public payers of health care services, including employer-provided health insurance and state and federal programs, such as Medicaid, Medicare, Indian Health Service, Federally Qualified Health Centers and the State Children's Health Insurance Program. For more details, see another report, Building a Financial Infrastructure: Health Plan Benefits and Provider Reimbursement.
    4. Community development and tailored population-based approaches to reach disparate populations. Half of tobacco users are economically disadvantaged and face hurdles in receiving health services that include cultural, language, geographic and financial barriers. Mainstream health care delivery systems are unlikely to reach such populations without special efforts to apply creative community development solutions. For more details, see Comprehensive Statewide Tobacco Cessation.
  • Comprehensive Statewide Tobacco Cessation also suggested that state tobacco cessation programs conduct outreach campaigns using communication strategies to influence public opinion and promote health care policy changes.

Communications

The Pacific Center distributed more than 2,600 reports and toolkits at professional meetings and to its members and national partners, who in turn distributed them to their networks of contacts. In addition, many users accessed information on the Web site, although no exact count of page requests is available. Pacific Center staff members made a series of presentations on quitlines in January 2003 to the Hawaii Trust Fund Advisory Board, which advises the Hawaiian legislature on spending tobacco settlement funds. Project staff made several other presentations at national conferences. (See Bibliography for details.)

 Back to the Table of Contents


LESSONS LEARNED

  1. Pooling resources and experiences of many states in face-to-face meetings and discussions yields more comprehensive strategies and recommendations than those gathered by any one state alone. By bringing together an interdisciplinary group of committed people, Pacific Center meetings led to broader and stronger approaches to tobacco cessation at the state level than any individual effort could have achieved. These discussions also allowed state representatives to adapt approaches that had already been developed, and to draw on available resources, such as contract language and tips for organizing a program. Many people said the contact lists they took away from meetings were among the most valuable products. (Project Director)
  2. States move at their own pace in applying lessons on tobacco cessation. The Pacific Center moved away from its initial plan to identify specific best practices that could be uniformly applied. Instead, it opted to help states design the frameworks that best met their own needs and then to provide implementation tools and case examples so that they could tailor their approaches to their own political and economic environments. (Project Director)
  3. Modifying project goals may be necessary to avoid duplication. The Pacific Center originally intended to develop criteria for evaluating quitlines within states, but funding was very limited, and other organizations were able to take on this role in conjunction with the new National Quitline Consortium; so it did not pursue the evaluation. (Project Director and Writer)

 Back to the Table of Contents


AFTER THE GRANT

In 2004, and with funding from the Centers for Disease Control and Prevention, the members of the Pacific Center joined with seven other state tobacco control programs—those of New Mexico, New Jersey, New York, Pennsylvania, Ohio, Oklahoma and Wisconsin—to create the Comprehensive Statewide Tobacco Prevention Cessation Leadership Project, an initiative designed to provide collaborative technical support to state cessation programs.

In September 2005, the project expanded nationally, creating the

Read more