March 15, 2010

DOLLARS AND SENSE

Tobacco-prevention advocacy set for March 17 to preserve funding for Ohio's cessation programs, including those for people with severe mental illness

—by Paul M. Kubek and Matthew K. Weiland

Columbus, OH—Funding for tobacco-prevention and cessation initiatives in Ohio is scheduled to end on June 30, 2010, and advocates are working hard not to let this happen. At risk are all tobacco-control programs that are designed to increase quality of life and reduce healthcare costs for individuals and families as well as private and public health insurance programs.

Among the funds that might be cut are those that support dissemination of "Tobacco: Recovery Across the Continuum" (TRAC), a service model designed specifically to help people diagnosed with severe mental illness and/or substance use disorders to reduce and eventually eliminate the use of tobacco products. People with severe mental illness are among the heaviest users of tobacco, especially cigarettes.

The TRAC model has been developed and is being disseminated by the Center for Evidence-Based Practices (CEBP) at Case Western Reserve University in collaboration with stakeholders in Ohio. TRAC is supported by the Ohio Departments of Health, Mental Health, and Alcohol and Drug Addiction Services.

STATEWIDE ADVOCACY DAY

Ohio's Medicaid system could save $550 million within five years if all Medicaid beneficiaries who smoke would quit.

As part of the statewide effort to preserve funding for all tobacco-cessation initiatives in Ohio, the CEBP will take part in "Investing in Tobacco-Free Youth Advocacy Day 2010," which aims to lobby policymakers and lawmakers for continued funding of Ohio's tobacco-control programs. The CEBP is encouraging others to join the effort.

The event will take place on Wednesday, March 17, 2010 at the Riffe Center in Columbus. This daylong event will consist of education and training workshops, strategizing sessions, and meetings with Ohio legislators. The event is hosted by the Investing in Tobacco-Free Youth Coalition, as well as the American Heart Association, American Cancer Society, and American Lung Association (learn more).

"TRAC" INITIATIVE IS UNIQUE

The TRAC model fills an important niche in tobacco-recovery services, because research shows that tobacco-cessation programs designed for the general population do not work for people diagnosed with severe mental illness and/or substance use disorders. Consider these statistics:

  • More than 75 percent of people diagnosed with a severe mental illness or substance use disorder consume tobacco products.
  •  In contrast, the rate of tobacco use in the general population has declined steadily to about 20 percent nationally.
  • Over 44 percent of the cigarettes smoked in the United States are consumed by people with psychiatric disorders.
  • People diagnosed with severe mental illness die, on average, 25 years earlier than their non-mentally ill peers. Many of these deaths are caused by tobacco-related illnesses, such as cancer, heart disease, and emphysema and other lung diseases.

TRAC reaches the population for which it is designed because it integrates tobacco treatment with comprehensive behavioral healthcare approaches. Services are delivered at mental-health or substance-abuse agencies: these are environments with which consumers are familiar and, thus, comfortable (learn how this may have impacted the outcome of Allena's recovery [click here]).

TRAC is a stage-based motivational service model that equips service providers with strategies to connect with people in all "stages of change," including people who are either unaware of or ambivalent about the benefits of reducing and eliminating tobacco use as well as those who are ready to reduce and become tobacco-free. In addition, TRAC encourages consumers to address all addictive substances at the same time. Research shows that simultaneous treatment for alcohol, tobacco and other drugs will likely increase abstinence by up to 25 percent.

POOR HEALTH, BIG MONEY IN OHIO

NEW REVENUE

Ohio lawmakers asked retailers to raise fees on the sale of cigarettes in 2003 and 2005 but not on other tobacco products (OTPs), such as cigars and smokeless and hookah tobacco. A correction of fee structures for OTPs would result in approximately $50 million per year and should be directed to the Ohio Department of Health.

— Investing in Tobacco-Free Youth (ITFY

Funding for TRAC and many other tobacco-prevention and cessation initiatives in Ohio comes from the November 1998 multistate tobacco settlement. The State of Ohio has been trying to divert this money away from tobacco control to supplant shortfalls in the State's budget. However, some studies indicate that tobacco-cessation programs would save Ohio a lot of money by reducing current healthcare costs and lost productivity. For instance, the 2007-2008 Progress Report of the American Legacy Foundation notes the following:

"The United States Centers for Disease Control and Prevention (CDC) estimates that tobacco use costs Ohio $4.7 billion every year in lost productivity and more than $4 billion in health care costs" (get PDF report, p38).

In addition, the American Legacy Foundation report also states that Ohio's Medicaid system could save $550 million within five years if all Medicaid beneficiaries who smoke would quit (see report, p38). Many people with severe mental illness rely upon Medicaid for primary healthcare and prescriptions for psychotropic medications that help them reduce and manage debilitating symptoms.

GOOD SOLUTION: CORRECT THE FEES FOR TOBACCO SALES

In addition to arguing for the preservation of existing funds for tobacco-control efforts, many advocates are fighting for a correction in the revenue for the programs. For instance, the advocacy organization Investing in Tobacco-Free Youth (ITFY) proposes that Ohio lawmakers should ask retailers to raise fees on other tobacco products (OTPs). These are non-cigarette forms of tobacco such as the following:

  • Cigars
  • Smokeless tobacco
  • Hookah tobacco

According to an advocacy pamphlet from ITFY, when legislators asked retailers to raise fees on the sale of cigarettes in 2003 and 2005, they failed to correct the fee structure for OTPs. A correction in the retail cost of OTPs would result in approximately $50 million per year, which, ITFY argues, should be directed to the Ohio Department of Health "to continue the high quality, science-based tobacco prevention and cessation programs that have in the past been funded in communities around the state and that are in line with best practices as recommended by the Centers for Disease Control" (get PDF pamphlet, click here).

The ITFY emphasizes that the amount of money generated by the OTP cost correction would be less than the amount that the tobacco industry spends in one month in Ohio.

ANOTHER REASON TO PRESERVE FUNDING

A December 2009 report from the Campaign for Tobacco-Free Kids (co-sponsored by other leading public health groups), titled "A Broken Promise to Our Children: The 1998 State Tobacco Settlement 11 Years Later," ranks Ohio a disappointing 45th among U.S. states in the amount it spends on tobacco-control efforts. The report found that Ohio is spending only 5.1 percent of the recommended minimum by the CDC.

The report reads, "Ohio's spending on tobacco prevention amounts to 0.6 percent of the estimated $1.18 billion in tobacco-generated revenue the state collects each year from settlement payments and tobacco taxes" (get PDF report, p71-72).


 SOURCES

1. "Investing in Tobacco-Free Youth Advocacy Day 2010."
Wednesday, March 17, 2010 at the Riffe Center in Columbus; hosted by the Investing in Tobacco-Free Youth Coalition, as well as the American Heart Association, American Cancer Society, and American Lung Association.
| learn more |

2. American Legacy Foundation (2009). "Fighting for Tobacco Settlement Dollars in Ohio." 2007-2008 Progress Report | The Voices of Change, p38. Downloaded March 5, 2010.
| get PDF resource |

3. Investing in Tobacco-Free Youth (2010). Press Resource. Media Kit. Downloaded March 5, 2010.
| get PDF resource |

4. Campaign for Tobacco-Free Kids (December 2009). A Broken Promise to Our Children: The 1998 State Tobacco Settlement 11 Years Later, p71-72.
| get PDF resource |

5. American Lung Association (2009). "A report card on Ohio's tobacco-prevention efforts." State of Tobacco Control 2009. Downloaded March 5, 2010.
| get resource |

6. Debra R. Hrouda & Barbara L. Wieder (2008). Nicotine Dependence: The Forgotten Substance-Related Disorder. Journal of Dual Diagnosis, v4, n2, p208-216.


Paul M. Kubek, MA, is director of communications and Matthew K. Weiland, MA, is senior writer, producer and new-media specialist at the Center for Evidence-Based Practices at Case Western Reserve University.
 

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