Improving Health in the Community A Role for Performance Monitoring (1997) / Chapter Skim
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A.7 Tobacco and Health
A.7 Tobacco and Health
Pages 300-323
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From page 300... ...
. Some of these deaths are nonsmokers affected by exposure to tobacco smoke and residential fires.
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Largely in response to the ill effects of environmental tobacco smoke, restrictions on public indoor smoking are increasingly widespread. California and Massachusetts have both increased excise taxes on cigarettes to encourage reduced consumption and to fund a variety of activities (e.g., media campaigns, school-based programs)
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Approximately 3,000 lung cancer deaths per year among nonsmokers have been attributed to environmental tobacco smoke (EPA, 1992)
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Low birth weight is associated with increased risks for morbidity and mortality. Reducing the prevalence of smoking during pregnancy is a readily identifiable goal that would contribute to improved pregnancy outcomes and longer-term infant health.
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This measure can be followed over time to track trends and can also be examined by age, race, and gender to identify those groups in which smoking behavior is changing. It might be revised to capture all tobacco use, including smokeless tobacco products.
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Increasingly, state and local laws restrict smoking in public spaces and workplaces, and more rigorous efforts are being made to enforce laws prohibiting tobacco sales to minors. These steps help create not only a legal but also a social environment that discourages tobacco use.
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3. Number of tobacco use cessation programs available in the community; their success rate (proportion of participants with at least six months of cessation following completion of the program)
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The many national, state, and community organizations that are dedicated to reducing tobacco use initiate and support efforts at the community level to address issues such as youth tobacco use, environmental tobacco smoke, and public policies. If such organizations are operating, communities might want to assess their effectiveness in local tobacco control efforts.
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Many states, counties, and municipalities have ordinances to control environmental tobacco smoke. Local ordinances will have to be assessed in the context of state laws, which may be sufficiently strict that local measures are not needed or, alternatively, may preempt the authority of local government to enact more stringent controls.
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Most health care resources are used in treating illness, and cure is generally not possible for more serious conditions such as lung cancer and emphysema. Many tobacco-related health risks can be reduced when people stop using tobacco products, and studies have demonstrated that tobacco cessation counseling by health care providers can increase cessation rates (see U.S.
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As noted above, recommendations have been issued that health care providers routinely ask about tobacco use and provide counseling for cessation or prevention (Smoking Cessation Guideline Panel, 1996; U.S. Preventive Services Task Force, 1996)
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Smoking cessation treatment has, however, been shown to be a cost-effective intervention (Cummings et al., 1989; Marks et al., 1990; Fiscella and Franks, 1996) , and coverage for tobacco assessment, counseling, and treatment has been recommended (Smoking Cessation Guideline Panel, 1996)
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Number of deaths in the community due to lung cancer, cardiovascular disease, emphysema, chronic bronchitis, respiratory infections; percentage of these deaths attributable to smoking. These measures largely fall under the community profile indicator on leading causes of death (indicator 12 in Appendix 5A)
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3. Extent to which state or local ordinances control environmental tobacco smoke in the community.
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and other national surveys might be a source of validated questions for a community survey. Smoking initiation is a product of many factors, so specific accountability cannot be established, but school-based prevention programs and enforcement of age restrictions on sales of tobacco products would be important priorities.
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8. Number of tobacco use cessation programs available in the community; their success rate (proportion of participants achieving at least six months of cessation following completion of the program)
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Counseling from health care providers of all types promotes cessation of tobacco use but is not offered routinely to all patients who use tobacco. HEDIS reporting on cessation counseling for adults would generate data on the performance of providers in health plans but not for the community as a whole.
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, risk factors (smoking prevalence, smoking initiation) , and community actions aimed at reducing tobacco use and, thus, its long-term health impact.
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Indicator 11, on health plan coverage for cessation programs, is an important measure in its own right and might provide an incentive for the development of smoking cessation programs in the community. REFERENCES CDC (Centers for Disease Control and Prevention)
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1996. Cost-Effectiveness of the Transdermal Nicotine Patch as an Adjunct to Physicians' Smoking Cessation Counseling.
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Public Health Reports 106:326–333. Smoking Cessation Guideline Panel.
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TABLE A.7-1 Field Model Mapping for Sample Indicator Set: Tobacco and Health Field Model Domain Construct Sample Indicators Data Sources Stakeholders Disease Reduce the impact of Deaths due to lung cancer, Death certificates Health care providers tobacco-related mortality cardiovascular disease, Health care plans respiratory diseases; State health agencies percentage of these deaths Local health agencies attributable to smoking Business, industry Community organizations A.7 TOBACCO AND HEALTH Special health risk groups General public Individual Reduce the prevalence Percentage of adults who Community State health agencies Response of smoking smoke regularly surveys Local health agencies Education agencies and Percentage of youth who Community or institutions initiate smoking each year school-based Community organizations surveys Special health risk groups General public Social Reduce youth access Effectiveness of enforcement Local (or state) State health agencies Environment to tobacco of local laws prohibiting government Local health agencies tobacco sales to minors enforcement Local government agencies Business, industry General public 321 continued on next page
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General public Physical Reduce exposure to Extent to which ordinances Local (or state) State health agencies Environment environmental control environmental government Local health agencies tobacco smoke tobacco smoke enforcement Local government agencies Business, industry General public Reduce loss of life and Number of residential fires Public safety property from fires attributable to smoking agencies IMPROVING HEALTH IN THE COMMUNITY
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Health Promote health care Percentage of tobacco users Community Health care providers Care provider counseling on whose health care providers surveys Health care plans cessation of tobacco use ask about tobacco use; Local health agencies provide cessation counseling; Business, industry assist cessation efforts General public Percentage of nonsmoking Community or Health care providers youth counseled by a health school-based Health care plans care provider not to begin surveys Local health agencies tobacco use General public A.7 TOBACCO AND HEALTH Reduce financial Percentage of health plans' Health plan Health care plans barriers to participation covered lives with partial or records State health agencies in cessation programs complete coverage for Local health agencies participation in tobacco Business, industry cessation programs General public 323
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