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Tobacco-Use Prevention Goes Up In Smoke

Potera, Carol

AJN, American Journal of Nursing: March 2013 - Volume 113 - Issue 3 - p 18
doi: 10.1097/01.NAJ.0000427868.20850.07
In the News

Spending for prevention will be only 1.8% of almost $26 billion collected by states.



Tobacco is the leading cause of preventable death in the United States, and smoking costs the nation $193 billion yearly—some $96 billion in medical costs and $97 billion in lost productivity, but only a miniscule part of annual tobacco settlement funds and taxes are used by states to fight tobacco use. In 2013, states will spend 1.8% of the $25.7 billion collected— a mere two cents on the dollar—to prevent smoking and help smokers quit. Funding for prevention programs fell 36% in the last four years and isn't being reinstated.

Only Alaska and North Dakota fund prevention programs at the level recommended by the Centers for Disease Control and Prevention (CDC). New Hampshire, New Jersey, North Carolina, and Ohio allocated no funds for the prevention of tobacco use for 2013. Yet every dollar spent on tobacco prevention saves five in health care costs. “Given such a strong return on investment, states are being truly penny-wise and pound-foolish in shortchanging tobacco prevention and cessation programs,” concludes a report from the Campaign for Tobacco-Free Kids and other groups, Broken Promises to Our Children: The 1998 State Tobacco Settlement 14 Years Later.

According to the report, supporting prevention programs in all states at CDC-recommended levels would require less than 15% of the $25.7 billion tobacco settlement money.

Each day 1,200 Americans die from tobacco use and 1,000 children start smoking. Studies show that prevention programs for youths can help deter children from smoking. Such programs in Maine cut smoking among high school students by 61%, and youth smoking fell by half in Washington State. And a new review suggests that interventions by primary care providers can be effective. The pooled analysis of 19 trials found that 19% fewer youths (average age, 11 to 17 years) started smoking after participating in programs conducted in health care settings. The prevention strategies varied greatly, however: some evaluated materials mailed to participants' homes, one included computers, one involved group educational sessions, and some included face-to-face advice and telephone counseling from health care providers, lead author Carrie D. Patnode, a research associate at Kaiser Permanente Center for Health Research in Portland, Oregon, told AJN.

School nurses and NPs in primary care clinics can be instrumental in screening school-age youths for tobacco use. School nurses can deliver positive media messages and provide counseling. Primary care NPs can consistently ask about smoking during assessments. “The question posed in a nonthreatening way can lead to early identification and intervention,” says Adelita Cantu, assistant professor of family and community health at the University of Texas Health Science Center at San Antonio.—Carol Potera

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Patnode CD, et al. Ann Intern Med 2012 December 11. [Epub ahead of print.]
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