should complete a comprehensive review to assess whether evidence-based prevention services are being offered and successfully delivered in federal health programs.

The federal government administers or funds Medicare; Medicaid; the Health Resources and Services Administration’s Community and Migrant Health Centers; Title X family planning clinics; the U.S. Department of Agriculture’s programs such as the Special Supplemental Nutrition Program for Women, Infants, and Children; the Indian Health Service; U.S. Department of Defense health programs; and Federal Employees Health Benefits Program. These programs do not always reflect best practices in cancer prevention and early detection.

The Medicare program, for example, does not cover any costs for smoking cessation treatment, and two-thirds of state Medicaid programs cover such treatments (Schauffler et al., 2001a). The lack of coverage for effective prevention services in public programs introduces a significant barrier to those most burdened by cancer: the uninsured population and members of racial and ethnic minority groups who often depend on federal programs for care. The availability of evidence-based prevention services should be ensured in these and other public programs. The Centers for Medicare and Medicaid Services (CMS, formerly the Health Care Financing Administration) is examining how a smoking cessation benefit might best be structured through a demonstration program.

Evidence-based prevention services should be available in these and other public programs. Therefore, a comprehensive review of the benefits being offered and the effectiveness of delivery systems is needed to identify opportunities to improve access to cancer prevention and early detection services in federal programs.

Recommendation 8: Programs are needed for health care providers to improve their education and training, monitor their adherence to evidence-based guidelines, and enhance their practice environments to support their provision of cancer prevention and early detection services.

Primary care providers in health care settings are effective agents of behavioral change. When counseled about smoking in clinical settings, 5 to 10 percent of individuals are able to quit. Evidence suggests, however, that physicians and other practitioners are not providing effective clinical interventions such as counseling and screening tests as often as would be beneficial. Fewer than half of adults who smoke cigarettes, for example, report that at their last visit the physician inquired whether they smoked.

Shortcomings in providers’ delivery of clinical preventive services can, in part, be traced to a lack of education and training. There is evidence of programmatic deficits in medical, dental, and nursing schools, despite nu-



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