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November 18, 2010 Volume VII, No. 20

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

Today is the 35th annual Great American Smokeout. This week's issue provides the latest stats on adult smoking and HHS's bold move to get smokers to quit and prevent non-smokers from starting. You will also learn about St. Jude Children’s Research Hospital's smoking cessation program for cancer survivors.

Fittingly, our e-survey this month is Tobacco Cessation and Prevention Programs. Take the survey and describe your efforts in this area.

Your colleague in the business of healthcare,
Jessica Papay
Editor, Disease Management Update

This week's DM news:

Table of Contents

  1. Smoking Among Adults Dropped
  2. New Graphics for Cigarette Packs
  3. Health Risk Assessments
  4. Motivational Interviewing for Behavior Change
  5. Top Coordinators of Care Transitions
  6. Lifestyle Management
  7. Smoking Cessation for Cancer Survivors
  8. Tobacco Cessation and Prevention Programs

Please pass this along to any of your colleagues or, better yet, have them sign up to receive their own copy and learn about our other news services.

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Please send comments, questions and replies to jpapay@hin.com.

Melanie Matthews, mmatthews@hin.com

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Smoking Among Adults Decreased in Past Three Decades

The proportion of adult smokers dramatically decreased during the past three decades in at least one metropolitan area — with more quitting and fewer picking up the habit, according to research presented at the American Heart Association’s Scientific Sessions 2010. The Minnesota Heart Survey included between 3,000 and 6,000 participants in each of its six surveys. Examining the smoking trends in adults 25 to 74 years old in the Minneapolis/St. Paul metropolitan area from 1980 to 2009, researchers found:

  • The number of current smokers was cut in half, decreasing from 32.8 to 15.5 percent in men and from 32.7 to 12.2 percent in women, with greater decreases among adults with higher income and more education.
  • Current smokers were smoking less. The age-adjusted average number of cigarettes smoked per day decreased from 23.5 to 13.5 in men and 21.1 to 10.0 in women.
  • Fewer Americans picked up the habit. Ever smokers — those who have smoked at least one hundred cigarettes and cigars in their life — dropped from 71.6 to 44.2 percent in men and from 54.7 to 39.6 percent in women.
  • Men continued to start smoking regularly at an average age of just under 18 years over the study period.
  • While women have also decreased cigarette use, the age they start smoking regularly has dropped from 19 to just under 18.
The percent of current smokers among men with more than high school education decreased from 29 to 11 percent. In contrast, current smoking in men who had just completed high school or had less education decreased from 42 to 31 percent. In women the numbers were different, but the trend was similar. Limitations of this work included the exclusion of people aged 18 to 24 years and the study of a population that was predominantly white and fairly educated.

The study didn’t address the impact of legislative changes such as increases in cigarette taxes. Smoking cessation efforts have made an impact; however, more emphasis needs to be placed on individuals in lower income brackets and those with less education, said researchers. “Present interventions are less effective in those of lower socioeconomic status. This group may not have the same access to medical care or the public health messages in the news media aren’t reaching them.” Researchers also stated that there needs to be a focus on younger women because societal changes and advertising may be having a negative influence. “The prevalence of smoking has been decreasing, but it remains a public health issue. There needs to be a better grasp on designing specific interventions for specific groups. A one-size-fits-all approach to stop smoking may not be as successful in some groups.”

To learn more about this research, please visit:

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New Warnings, Graphics for Cigarette Packs and Ads Proposed as Tobacco Control Strategy

HHS unveiled a new comprehensive tobacco control strategy that includes proposed new bolder health warnings on cigarette packages and advertisements. Once final, these health warnings on cigarettes and in cigarette advertisements will be the most significant change in more than 25 years. These actions are part of a broader strategy that will help tobacco users quit and prevent children from starting. The strategy includes a proposal issued by the FDA.

The proposed rule requires nine new larger and more noticeable textual warning statements and color graphic images depicting the negative health consequences of smoking appear on cigarette packages and in cigarette advertisements. The public can comment on 36 proposed images through January. By June 2011, the FDA will select the final nine graphic and textual warning statements after a comprehensive review and results from an 18,000 person study. Implementation of the final rule in September 2012 will ultimately prohibit companies from manufacturing cigarettes without new graphic health warnings on their packages for sale or distribution in the United States. In addition, manufacturers, importers, distributors and retailers will no longer be allowed to advertise cigarettes without the new graphic health warnings in the United States. By October 2012, manufacturers can no longer distribute cigarettes for sale in the United States that do not display the new graphic health warnings.

Tobacco use is the leading cause of premature and preventable death in the United States, responsible for 443,000 deaths each year. Thirty percent of all cancer deaths are due to tobacco. Each day 1,200 lives of current and former smokers are lost prematurely due to tobacco-related diseases.

To learn more about this research, please visit:

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Health Risk Assessments — Administration, Delivery and Completion Benchmarks

Who's using health risk assessments (HRAs), and how are they administered? What are the top incentives driving HRA completion, and what are the top three uses for HRA data? What completion rates can be expected?

In this month's healthcare benchmarks podcast, Healthcare Intelligence Network executive VP and COO Melanie Matthews shares the latest market research on HRA use. This month's metrics are derived from HIN's June 2010 survey on HRAs, with commentary from Dr. Marcia Wade, Aetna Medicare’s senior medical director.

To listen to this complimentary HIN podcast, please visit:

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Motivational Interviewing for Behavior Change

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Ariel Linden, Dr.P.H., M.S., president of Linden Consulting Group.

Question: Which care management interventions have proven effective in targeting behavior change for populations who face such challenges as access to computers, health literacy and possibly socioeconomic burden?

Response: Motivational interviewing has proven to be effective, in general, across different populations, health status levels and minorities; it has been proven in several different countries and regions in the world as well.

If you want people to change their behaviors, this is not a shotgun approach. You cannot do a population approach to changing people’s behaviors; it has never been proven to be effective. Placing public health campaigns that say “stop smoking” on billboards hasn’t stopped anybody from smoking. You need to get in the trenches and have individual contact with people or small groups. Small groups have been effective, too. You can look at the Stanford experiences in improvement and self-efficacy. Those interventions are successful in getting people to change their behaviors regardless of class level or ethnicity. If you don’t have direct communication with individuals, nothing is going to happen.

For more information on care management and behavior change, please visit:

We want to hear from you! Submit your question for Disease Management Q&A to info@hin.com.

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There are other free email newsletters available from HIN!

ReadmissionsRx delivers strategies to reduce hospital readmissions that encompass care plan development, case management, care transitions, pre- and post discharge planning, medication reconciliation and much more — with a special focus on reducing rehospitalizations among the Medicare population.

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Top Coordinators of Care Transitions

Tighter management of transitions in care can help to close care gaps and reduce rehospitalizations, ER visits and medication errors. We wanted to see which staff members have chief responsibility for the management of care transitions.

Click here to view the chart.

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Changing Lives with Lifestyle Management

Numerous healthcare organizations are launching lifestyle management programs for individuals with life-threatening conditions such as diabetes, heart disease and obesity. This white paper summarizes more than 60 such initiatives, including the differing approaches and techniques in identification, treatment and outcome assessment.

To download this complimentary white paper, please visit:

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Smoking Cessation Program Open to Cancer Survivors Who Need Help Quitting

Cancer survivors who smoke and need help quitting can receive help through a tobacco cessation program organized by St. Jude Children’s Research Hospital. The Cancer Survivor Tobacco Quit Line is open to survivors of childhood or adult-onset cancer, regardless of where they received treatment. Participation in the program is free. Despite the known risk of tobacco use, many cancer survivors still smoke. Cancer and its treatments put some survivors at increased risk for second cancers and conditions such as diabetes, heart disease and stroke. Smoking adds to health risks.

In recent years, smoking prevention and cessation efforts in the United States have included public smoking bans, the establishment of toll-free quit lines and the Great American Smokeout event nationwide, which is organized annually to encourage smokers to quit. To address the unique needs of cancer survivors who smoke, St. Jude created the Cancer Survivor Tobacco Quit Line through a grant from the National Cancer Institute. The quit line first started as a smoking cessation program aimed at childhood cancer survivors, but this year the program expanded to include survivors of adult-onset cancer as well.

Through the quit line, participants are assigned to one of two interventions: a counselor-initiated group or a self-paced group. All of the St. Jude counselors hold advanced degrees and have professional experience in public health to assist participants in preparing to quit, setting quit dates and avoiding relapses. In the counselor-initiated group, St. Jude counselors call participants six times during an eight-week period. Smokers in the self-paced group receive the same intervention but are responsible for phoning the counselors. All participants receive nicotine-replacement therapy in the form of patches or gum.

Participation in the quit line study is confidential, and survivors may end participation at any time. To qualify, survivors must be 18 years or older; speak English; have telephone access and live in the U.S.

To learn more about this research, please visit:

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Tobacco Cessation and Prevention Programs

The financial and clinical costs of smoking have been well documented. What is your organization doing in the areas of tobacco cessation and prevention? Complete HIN's Survey of the Month on tobacco cessation and prevention by November 30 and receive a free executive summary of the compiled results. Almost 50 companies have responded so far. Your responses will be kept strictly confidential.

To participate in this survey and receive its results, please visit:

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