AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES

Resolution:         __(A-03)

Introduced by:   American College of Preventive Medicine

Subject:             Support for federal Interagency Committee on Smoking and Health Report

Referred to:        Reference Committee ___

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Whereas, Smoking prevalence in adult Americans has stabilized at 23 to 25 percent since 1990, with an additional 4 to 6 percent of adult males using spit tobacco and sales of spit tobacco products steadily increasing; and

Whereas, Steps To A HealthierUS, a bold, new prevention initiative of the Secretary of Health and Human Services, emphasizes that avoiding tobacco use is the single most preventable cause of death and disease in the United States; and

Whereas, Epidemiologic data reveal that approximately 70 percent of adult smokers desire to quit smoking completely¹; and

Whereas, Numerous evidence-based tobacco dependence treatments exist, which not only double the likelihood of long-term abstinence, but also are among the most cost-effective healthcare practices; and

Whereas, Numerous effective community and policy interventions that promote smoking cessation exist; and

Whereas, Secondhand smoke has been shown to increase the risks of asthma, respiratory infections, cardiovascular diseases and lung cancer among nonsmokers, especially children and fetuses; and

Whereas, Access to smoking cessation treatments, through Medicaid, Medicare, or managed care organizations, is insufficient, particularly for racial and ethnic minorities and the poor; and

Whereas, The estimated healthcare costs of tobacco use are $75 billion per year, and the non-medical costs are estimated to exceed $150 billion per year incurred by government, employers, insurers, and individuals; and

Whereas, Increases in cigarette taxes reduce purchasing and use, particularly in youth and the economically disadvantaged, and, according to a recent report of the DHHS Interagency Committee on Smoking and Health Subcommittee on Cessation², a $2.00 increase in the federal excise tax would reduce cigarette sales by over 4 billion packs per year, achieve a 10 percent reduction in adult smoking prevalence, and cause an estimated 4.7 million smokers to quit; and

Whereas, The American Medical Association testified before the Interagency Committee on Smoking and Health in support of the recommendations, which would prevent 3 million premature deaths and help 5 million smokers quit when implemented, put forth by the Subcommittee on Cessation; therefore be it

RESOLVED, That our American Medical Association endorse the following proposals approved by the federal Interagency Committee on Smoking and Health on February 11, 2003:

1. establish a federally-funded National Tobacco Quitline network;
2. implement an ongoing, extensive paid media campaign to help Americans quit using tobacco;
3. include evidence-based counseling and medications for tobacco cessation in benefits provided to all Federal beneficiaries and in all federally-funded healthcare programs by FY 2005;
4. invest in a research agenda by FY2005 to improve the access, effectiveness and utilization of tobacco dependence interventions for individuals and populations;
5. invest in clinician education and training by FY 2005 to provide the necessary knowledge, skills, and support systems to help patients quit tobacco use; and
6. establish the Smokers’ Health Fund by FY 2005 through revenue generated through an increase in the Federal Excise Tax on cigarettes by $2.00 per pack and similar increases on other tobacco products, with at least 50 percent of revenue for the Fund being used to implement these proposals; and be it further

RESOLVED, That our AMA send a letter to the Secretary of Health and Human Services urging the Department to adopt the recommendations, in their entirety, of the Interagency Committee on Smoking and Health.

Fiscal Note: No Significant Fiscal Impact.

References:

1. Centers for Disease Control and Prevention. Cigarette smoking among adults—United States, 1995. MMWWR Morb Mortal Wkly Rep 1997;46(51):1217-20.
2. Subcommittee on Cessation. MC Fiore (Chair). Interagency Committee on Smoking and Health. Preventing 3 million premature deaths, helping 5 million smokers quit: a national action plan for tobacco cessation. Draft dated February 3, 2003.

H-490.926 Medicaid and HMO Support for Smoking Cessation.
Our AMA: (1) requests Congress to provide matching funds for Medicaid coverage for evidence-based programs and FDA approved products that lead to smoking cessation; and (2) seeks the requirement that state Medicaid programs, prepaid health plans and insurance companies provide evidence-based approaches for smoking cessation and nicotine withdrawal, including FDA-approved pharmacotherapy, as part of their standard benefit packages. (Res. 421, A-98)

H-490.932 AHCPR Smoking Cessation Clinical Practice Guideline.
The AMA will continue to cooperate with the Agency for Health Care Policy and Research (AHCPR) in disseminating and implementing an evidence-based clinical practice guideline on smoking cessation and in matters related to tobacco and health. The AMA encourages the use of practice guidelines for the treatment of patients with nicotine dependence. (Res. 415, A-96; BOT Rep. 10, A-97)

H-490.943 Tobacco and Smoking.
Our AMA: (1) supports health insurance coverage and reimbursement for smoking cessation efforts; and (2) encourages state medical associations to develop lists of pharmacies that have voluntarily banned the sale of tobacco for distribution to their members. (Res. 427, I-92; Reaffirmation A-97; Reaffirmation I-99; Reaffirmation A-01)

H-490.963 Physician Training Programs to Promote Smoking Prevention and Cessation.
The AMA (1) supports efforts to identify gaps, if any, in existing materials and programs designed to train physicians and medical students in the behavior modification skills necessary to successfully counsel patients to stop smoking; (2) supports the production of materials and programs which would fill gaps, if any, in materials and programs to train physicians and medical students in the behavior modification skills necessary to successfully counsel patients to stop smoking; (3) supports national, state, and local efforts to help physicians and medical students develop skills necessary to counsel patients to quit smoking; (4) encourages state and county medical societies to sponsor, support, and promote efforts which will help physicians and medical students more effectively counsel patients to stop smoking; and (5) supports providing assistance in the promulgation of information on the effectiveness of smoking cessation programs. (Sub. Res. 12, A-88; Sub. Res. 192, A-89; CLRPD Rep. 2 - I-94; Res. 418, A-95)

H-490.973 Smoking Cessation.
Our AMA urges all physicians to use smoking cessation activities in their practices. These could include:

(1) quitting smoking and urging their colleagues to quit; 

(2) inquiring of all patients at every visit about their smoking habits (and their use of smokeless tobacco as well);

(3) counseling at every visit those who smoke to quit smoking;

(4) prohibiting all smoking in the office by patients, physicians, and office staff;

(5) providing smoking cessation pamphlets in the waiting room;

(6) becoming aware of smoking cessation programs in the community and of their success rates and, where possible, referring patients to those programs;

(7) participating in education programs to help physicians help patients quit smoking; and

(8) speaking to community groups about tobacco use and its consequences. (CSA Rep. E, I-87; Reaffirmed by Res. 418, A-95; Reaffirmation A-99; Reaffirmation A-00)