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November 19, 2009 Volume VI, No. 27

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

In response to today's 34th annual Great American Smokeout, this issue of the DM Update is all about smoking — from smoking rates in the U.S. to employer and employee takes on workplace smoking bans to tips on changing unhealthy behaviors.

In addition, learn how the American Cancer Society's Great American Smokeout can help smokers to quit smoking.

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

This week's DM news:

Table of Contents

  1. U.S. Adult Smoking Rates
  2. Supporting Workplace Smoking Bans
  3. Case Management in the Medical Home
  4. Overcoming Resistance to Changing Unhealthy Habits
  5. Healthcare Trends: Smoking Cessation
  6. Great American Smokeout
  7. Reducing Hospital Readmissions

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

Melanie Matthews, mmatthews@hin.com

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U.S. Adult Smoking Rates Remain Stalled

Despite progress in some areas, smoking rates among U.S. adults remained stalled in 2008, halting the nation’s progress in ending the tobacco epidemic, according to a new CDC study. The study, released in advance of the annual Great American Smokeout, found that 46 million Americans (20.6 percent) were current cigarette smokers in 2008, which is virtually unchanged since 2004 when 20.9 percent of adults reported being smokers. The study’s findings indicate an alarming trend, because smoking is the leading preventable cause of death, killing more than 443,000 people every year and costing the nation $96 billion in healthcare costs annually. This new data, based on the 2008 National Health Interview Survey, shows little to no change over the past five years and hints that smoking rates may be moving in the wrong direction.

According to the study, the people hardest hit by the tobacco epidemic are those among vulnerable populations, including people with lower levels of educational attainment. In 2008, 41.3 percent of persons with a general education development certificate smoked cigarettes, compared to 5.7 percent of persons with a graduate degree.

In another study in this week’s CDC Morbidity and Mortality Weekly Report, the 2008 Behavioral Risk Factor Surveillance System reports that current adult smoking prevalence varied substantially across 50 states, the District of Columbia and the three U.S. territories. Among states, smoking prevalence was highest in West Virginia (26.6 percent), Indiana (26.1 percent) and Kentucky (25.3 percent), and lowest in Utah (9.2 percent), California (14 percent) and New Jersey (14.8 percent). In the same study, the CDC also reported significant variation among 11 states in the proportion of adults protected by smoke-free workplace policies and the proportion of adults who protect themselves and their families from secondhand smoke in their homes.

Among the 11 states that asked questions about exposure to second-hand smoke, there was a large variation in indoor workplace exposure — from a high of 16 percent in Mississippi to a low of 6 percent in Connecticut and Tennessee. In these states, home exposure varied widely from 3 percent of adults exposed in their homes in Arizona to 10.1 percent and 10.6 percent, respectively, in Mississippi and West Virginia. This finding correlates with household policies about not allowing smoking in households with a smoker present — for example, two thirds of smokers in Arizona live in households where smoking is not allowed in the home, compared to 41 percent and 36 percent in Mississippi and West Virginia. Nationwide, 21 states and D.C. have implemented comprehensive smoke-free laws covering workplaces, restaurants and bars, but more than half of the country still lives in areas where they are not protected by comprehensive smoke-free laws.

To learn more about this research, please visit:

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Smokers Worldwide Support Workplace Smoking Bans

The majority of smokers worldwide support smoking bans in the workplace, according to a new study by RTI International and Harris Interactive. The study, published in the "International Journal of Public Health" online edition, surveyed more than 3,500 employees who smoke and more than 1,400 employers (both smokers and nonsmokers) in 14 counties about their attitudes toward workplace smoking and cessation. The participating countries included South Korea, Japan, China, Taiwan, India, United Kingdom, Italy, Sweden, France, Germany, Spain, Poland, Turkey and Brazil.

The results showed that 74 percent of smoking employees and 87 percent of employers felt that the workplace should be smoke free. The greatest support for workplace smoking bans was in India (85 percent) and Japan (75 percent). In contrast, only one-third of employees in Germany (33 percent) and Poland (37 percent) agreed with a workplace smoking ban.

The study also found that overall employees estimated spending an average of one hour per day smoking at work, but most employees (almost 70 percent) did not believe that smoking had a negative financial impact on their employer. However, about half of employers interviewed did believe that smoking had a negative financial impact on their organization. "Several previous studies indicate that despite the beliefs of smoking employees and some employers in our study, smoking does have a substantial negative impact on a business's finances," said Michael Halpern, Ph.D., a senior fellow at RTI and the paper's lead author. "More research needs to be done to quantify the economic impacts of workplace smoking and educate both employers and employees on those effects."

To learn more about this research, please visit:

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Effective Case Management in the Medical Home

Case managers are the backbone of the Geisinger Health Plan (GHP) Health NavigatorSM program, a medical home partnership between primary care providers and GHP that has reduced 30-day hospital readmissions by 15 to 20 percent. Providing benchmarks for case manager caseloads and contact frequency, tools to support the case management effort, the key to smooth placement of case managers in the medical home and tips for better management of patients discharged to nursing facilities are Diane Littlewood, R.N., and Joann Sciandra, R.N., both regional managers of case management for health services at Geisinger Health Plan.

To listen to this complimentary HIN podcast, please visit:

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Overcoming Resistance to Changing Unhealthy Habits

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Dr. Richard Botelho, M.D., professor of family medicine at the University of Rochester Medical Center.

Question: How can physicians help individuals overcome their resistance to changing their unhealthy habits?

Response: The learning process of developing personal evidence can help you overcome your own resistance to changing your unhealthy habits. None of us have got perfect health habits. In order to actually do this we need to go beyond “surface change.” Surface change involves increasing our knowledge, having good intentions — like New Year’s resolutions — and setting goals. If that works, that’s fine. But if it doesn’t, we have to go a step further to explore “deep change.” Making deep change can involve a number of different activities. For example, it might involve changing your perceptions — about how you perceive the risks, benefits and harms about your unhealthy habits. It could involve exploring or addressing your differences and your values between what you say and what you actually do. For example, we all say that we value our health but we don’t always do it. How do you deal with that discrepancy? Lastly, learn how to lower your emotional resistance in order to develop effective motivation to change. These learning processes can help you overcome the limitations of evidence-based guidelines. We need new ways of dealing with the fact that most of us don’t change when we’re using evidence-based guidelines.

For more information on health coaching and behavior change in primary care, please visit:

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

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Benchmarks in Tobacco Cessation and Prevention Programs

By funding an expansion of healthcare coverage for children with a 61-cent tobacco tax per cigarette pack, the U.S. government is doing their part in the crusade for tobacco cessation and prevention. Now, HIN examines how over 220 wellness companies, behavioral healthcare providers, PCPs, DM organizations, employers, health plans and hospital/health systems are contributing to the area of tobacco cessation and prevention.

To download this complimentary white paper, please visit:

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American Cancer Society Marks 34th Great American Smokeout® by Encouraging Smokers to Quit

As the official sponsor of birthdays, the American Cancer Society marks the 34th Great American Smokeout today by encouraging smokers to use the date to make a plan to quit, or to plan in advance and quit smoking that day. By doing so, smokers will be taking an important step towards a healthier life — one that can reduce cancer risk and create more birthdays. Researchers say that quitting smoking can increase life expectancy — smokers who quit at age 35 gain an average of eight years of life expectancy, those who quit at age 55 gain about five years and even long-term smokers who quit at age 65 gain three years.

The Great American Smokeout Web site, www.cancer.org/GreatAmericans, contains user-friendly tips and tools towards a smoke-free life. In addition to tip sheets and calculators, the site also offers downloadable desktop helpers to assist with planning to quit and succeeding in staying tobacco-free. The Quit Clock allows users to pick a quit day within 30 days, then counts down the selected day with tips for each day; and the Craving Stopper helps smokers beat cravings by offering a fun distraction.

The American Cancer Society created the trademarked concept for and held its first Great American Smokeout in 1976 as a way to inspire and encourage smokers to quit for a day. One million people quit smoking for a day at the 1976 event in California. The Great American Smokeout encourages smokers to commit to making a long-term plan to quit smoking for good.

To learn more about this research, please visit:

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Reducing Hospital Readmissions

The frequency and financial impact of Medicare readmissions, the posting of readmission rates for Medicare patients with heart attack, heart failure and pneumonia on the CMS Hospital Compare site and the tying of these rates to reimbursement are making healthcare organizations work harder to keep patients from returning to the hospital. Describe your organization's efforts by taking the HIN 2009 Hospital Readmissions Benchmark Survey and receive an e-summary of the results once the survey is completed.

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

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