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February 4, 2010 Volume VI, No. 36

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

Tobacco now claims at least 1.3 billion users and kills more than 14,500 people every day, while debilitating and sickening many times that number. In this issue, discover whether cigarette smoking can increase Alzheimer's disease risk as well as whether stopping smoking benefits lung cancer patients.

On the prevention front, a new report outlines 21 challenges and needs for global tobacco control, and 220 companies describe their smoking cessation programs.

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

This week's DM news:

Table of Contents

  1. Smoking & Alzheimer's
  2. Should Lung Cancer Patients Quit Smoking?
  3. HRAs for the Elderly
  4. Health Coaches, Smoking & ROI
  5. Healthcare Trends: Benchmarks in Tobacco Cessation and Prevention
  6. 21 Global Tobacco Control Ideas
  7. Health & Wellness Incentives Use

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

Melanie Matthews, mmatthews@hin.com

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Cigarette Smoking Risk for Alzheimer's Disease

A University of California, San Francisco (UCSF) analysis of published studies on the relationship between Alzheimerís disease (AD) and smoking indicates that smoking cigarettes is a significant risk factor for the disease. The UCSF research team also found an association between tobacco industry affiliation and the conclusions of individual studies. Industry-affiliated studies indicated that smoking protects against the development of AD, while independent studies showed that smoking increased the risk of developing the disease.

The UCSF team reviewed 43 published studies from 1984 to 2007. Authors of one-fourth of the studies had an affiliation with the tobacco industry. The UCSF team determined that the average risk of a smoker developing AD, based on studies without tobacco industry affiliation, was estimated to be 1.72, meaning that smoking nearly doubled the risk of AD. In contrast, the team found that studies authored by individuals with tobacco industry affiliations showed a risk factor of .86 (less than one), suggesting that smoking protects against AD. When all studies were considered together, the risk factor for developing AD from smoking was essentially neutral at a statistically insignificant 1.05.

According to the Alzheimerís Association, 5.3 million Americans currently have AD, and that number will escalate rapidly as the baby boom generation ages. AD also triples healthcare costs for Americans aged 65 and older, the organization states.

To learn more about this research, please visit:

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Lung Cancer Patients Who Quit Smoking Double Chances of Survival

Patients who are diagnosed with early stage lung cancer can double their chances of survival over five years if they stop smoking compared with those who continue to smoke, according to researchers at the University of Birmingham in England. Scientists suggest that offering smoking cessation treatment as part of early stage lung cancer patients' therapy could be valuable.

Researchers undertook the first ever review of studies that measure the effects of continued smoking after diagnosis of lung cancer. There is an established link between smoking and lung cancer; lifelong smokers have a 20-fold increased risk compared with non-smokers. However, until now scientists have not known if cessation on diagnosis can improve prognosis. According to Amanda Parsons, research fellow at the University of Birmingham, "we found that people who continued to smoke after a diagnosis of early stage lung cancer had a substantially higher risk of death and a greater risk of the tumor returning compared with those who stopped smoking at that time. The data suggests that most of the increased risk of death was due to cancer progression." The research team also found that about twice as many quitters would survive for five years compared with continuing smokers, with a five-year survival rate of 63-70 percent among quitters compared with 29-33 percent among those who continued to smoke.

"The key message is that it is never too late to give up smoking. Benefits can be seen even when you have been diagnosed with lung cancer. Our review suggests that continued smoking may affect the behavior of a lung tumor and that smoking cessation for those with early stage lung cancer can make a real impact on survival rates," said Parsons.

To learn more about this research, please visit:

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Assessing and Predicting Health Risk in the Elderly

Even though more than a third of the elderly are online, they're not necessarily using the Internet to seek health assistance, explains Marcia Wade, M.D., F.C.C.P., M.M.M., senior medical director at Aetna Medicare. That's why Aetna delivers its health risk assessment for the elderly in an alternate format while making available other Web-based tools to tech-savvy boomer beneficiaries. Dr. Wade also describes Aetna's user-friendly strategy for heading off high-risk complications among its elderly and how this contributes to an overall reduction in hospital readmissions.

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Health Coaches Fuel Smoking Cessation ROI

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Dr. Elizabeth Rula, principal investigator of Health Outcomes Research at Healthways Inc.

Question: With what factors have health coaches made the largest impact on ROI?

Response: (Dr. Elizabeth Rula) Exercise and diet are huge components. Both are risk factors that can lead to multiple different chronic conditions, primary diabetes and heart disease. Also, there is definitely a link between these risk factors and productivity. It is obvious that as people become thinner as they exercise more and have a healthier diet, they would have a great energy level that would improve their productivity. But to expand upon that, smoking is a risk factor that has a clearly established link to increased costs. Although this might not be an effect at this point — luckily smoking rates are going down to some extent — there is still a huge proportion of the population, especially in certain employer groups, who smoke. This is clearly an area where savings is possible.

For more details on health coaching and ROI, please visit:

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Healthcare Trends & Studies: Benchmarks in Tobacco Cessation and Prevention Programs

Who are the target populations for smoking cessation programs, and how are incentives driving engagement and participation in these efforts? How do tobacco cessation programs identify candidates and deliver the information to participants? This HIN white paper examines the prevalence of tobacco cessation and prevention among 220 wellness companies, behavioral healthcare providers, PCPs, DM organizations, employers, health plans and hospital/health systems who responded to a recent survey on this topic.

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Report Outlines 21 Challenges and Needs for Global Tobacco Control

A new American Cancer Society report outlines 21 challenges and needs for global tobacco control to reduce the rising tide of tobacco use worldwide, particularly in the low- and middle-income nations that are the target of the multinational tobacco industry.

The report's authors point out that it is only in the past 50 years that public health has responded to the death, disease and economic disruption caused by tobacco use. Tobacco now has at least 1.3 billion users and kills more than 14,500 people every day, while debilitating and sickening many times that number. The report lists activities, policies and interventions to successfully reduce the rising tide of tobacco use.

The report calls for increased support for and adherence to the Framework Convention on Tobacco Control (FCTC). The report calls this the single most important action in the effort to eliminate tobacco-related death and disease, saying all governments should be encouraged to join the more than 165 nations who already have ratified the treaty, and that those who have joined the Framework should faithfully implement it. One challenge is the use of tobacco by physicians and other healthcare providers. Many physicians and healthcare providers continue to use tobacco, with use reported to be as high as 50 percent or more in some countries.

To learn more about this research, please visit:

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Health & Wellness Incentives Use

The use of economic incentives to drive engagement and results from wellness and prevention programs continues to proliferate, both as a response to escalating healthcare costs and a shift of more health ownership to consumers. Please share how your organization uses incentives to promote health and wellness by completing HIN's second annual Survey of the Month on this topic by February 28, 2010. You'll receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

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

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