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Legislators of Two Minds about Tobacco Cessation Programs

Members of the General Assembly voted to cut and limit tobacco cessation programs in North Carolina, on the same day they resolved to honor victims of lung disease.

By Rose Hoban, with reporting by Kelsey Tsipis

Leaders in North Carolina’s House of Representatives can’t seem to decide whether they like smoking cessation programs, or not.

On the same day the House passed a budget that would significantly cut funds for tobacco cessation, the House also adopted a resolution marking COPD Awareness day at the General Assembly.

COPD, or chronic obstructive pulmonary disease, is cluster of diseases that includes emphysema and chronic bronchitis. More than 90 percent of COPD cases are caused by smoking, and estimates put the cost of COPD at $50 billion nationwide annually.

Last Wednesday morning, House member Tom Murry (R-Morrisville) also sponsored a press conference to mark COPD Awareness Day, aimed at raising awareness about COPD and its effects on North Carolina families.

At the conference, Murry’s guest, Duke pulmonologist Dr. Roy Pleasents praised the state’s tobacco cessation programs. Pleasents talked at length about Duke Medicine’s reliance on the state’s Quitline to help patients quit smoking.

Pleasents also called lawmakers’ decision to cut programs a “disaster,” and said they “couldn’t have come at a worse time.”

About twelve hours later, the House passed its budget, trimming the amount allocated for smoking cessation programs by two-thirds.

Budget history

In the 1990s, attorneys general from around the country sued tobacco companies over the costs incurred by states to treat Medicaid patients with smoking-related diseases. The Master Settlement Agreement was finalized in 1998, and was intended to compensate states for the costs of treating patients with smoking-related diseases.

This year, North Carolina will receive $144 million dollars from the MSA.

Health & Wellness Trust Fund logo

Last year, the state spent $17 million on tobacco control programs, channeled primarily through the Health and Wellness Trust Fund, created by the General Assembly to handle about a quarter of the state’s annual MSA money and use it for health programming. In last year’s budget, legislators disbanded the Trust Fund, moving the 2011 allocation to the state Division of Public Health as non-recurring dollars.

When Gov Bev Perdue was Lt. Governor, she chaired the Fund. So, advocates were disappointed when Perdue’s 2012 budget trimmed funds for tobacco cessation to $10 million.

But this year’s House budget cuts funds for tobacco cessation activities further, allocating only $5.46 million for statewide programs. In addition, the House budget includes a special provision expressly prohibiting statewide media campaigns, such as the Tobacco. Reality. Unfiltered. commercials aimed at young people.

An additional $8.47 million allocation would go to local health departments to run smoking cessation programs, along with programs to promote nutrition and physical activity, to pay for disease prevention, school nurses, and to reduce obesity.

When asked during Wednesday morning’s press conference about cuts to the state budget for tobacco control, Rep. Murry responded that more focus was being put on county health departments, allowing them to make the more appropriate decision on tobacco cessation programs.

NC House of Representatives meets into the evening to debate the state budget, May 30, 2012

NC House of Representatives met late into the evening to debate the state budget, May 30, 2012

“We want to make sure every county has a fully funded, enabled health department to do whatever health screening and health analysis that they can do,” said Murry, who sits on the HHS oversight committee.

North Carolina has 86 local health departments. Divided evenly, the prevention money comes to about $98,500 per department.

“And that $8.5 million is not dedicated to tobacco prevention,” said Peg O’Connell, spokeswoman for several health care advocacy organizations. “The counties get to choose what they use it for.”

O’Connell argued that in local health departments, undesignated dollars usually get spent for immediate problems, like an outbreak of mosquito borne illness, or of a food-borne illness. Long-term projects tend to get the short shrift.

“The emergent is always going to take precedence,” O’Connell said.

QUITLINE “highly effective”

The upcoming cuts would also trim dollars for the Quitline O’Connell said, or would siphon off dollars for other control measures.

More than 45 states and territories have Quitlines, according to Jesse Saul from the North American Quitline Consortium. The NACQ website shows statistics from all of the states.

Logo for NC Quitline

Image courtesy of the Tobacco Control Branch, NC DHHS

At a rate of 36 cents per person in 2011, North Carolina ranked 30th in the country in per capita spending on smoking cessation programs. In a Best Practices document, the CDC recommends states spend $2.19 per person on Quitlines and tobacco cessation programs.

“It’s a pay me now or pay me later proposition,” Saul said, referring to the fact that states spend money up front on preventing tobacco use, or but also end up spending Medicaid dollars later treating COPD, lung cancer and other diseases related to smoking.

Duke pulmonologist Roy Pleasents said doctors at his clinic recommend the Quitline to almost all their patients.

“That is a key resource in the context of tobacco related disease and the expectation by the Joint Commission (the US’s main hospital accreditation organization) and committes on Medicaid and Medicare services,” said Pleasents. “And the use of the Quitline has gone up exopnetentially.”

Last year, the Quitline cost North Carolina about $1.9 million. The program had money left from from the dissolution of the Health and Wellness Trust Fund, and so leaders spent an additional $980,000 in the first part of this year providing nicotine patches to callers who requested them.

Calls to the service jumped from about 300 calls per week at the end of last year, to more than 1,500 in May, between the nicotine patch program and a statewide commercial campaign highlighting the Quitline. During May, North Carolina’s Quitline had the highest call volume of any in the country.

Locals only

A special provision in the House budget also forbids spending on statewide tobacco cessation marketing and media campaigns, limiting the programs to county programs.

House leaders have maintained the change in strategy was to emphasize local preventitive measures instead of a “one size fits all” approach done at the state level.

Durham Tobacco Co advertisement

NC State Fair Premium List, 1893. Image courtesy of Government & Heritage Library, North Carolina State Library, via Flickr Creative Commons

During the budget debate last Wednesday, HHS appropriations co-chair Rep Justin Burr (R-Albemarle) argued that putting more money to statewide programs would take dollars from “they who know what’s best on the community level.”

“Tobacco companies despise statewide media,” said Stan Glantz, a nationwide anti-smoking advocate based at the University of California at San Francisco. “It’s the single most effective thing to do to reduce smoking. And the companies fight them like tooth and nail everywhere.”

Glantz recently published a study about how legislators in North Dakota moved tobacco prevention dollars to local health departments, which then banded together to pay for a statewide campaign.

“This provision in North Carolina would prohibit the health departments from being as creative as they were in North Dakota,” Glantz said.

North Carolina remains a tobacco-producing state where the political action committee for Winston-Salem based RJ Reynolds alone has given more than $120,000 to legislators since the beginning of 2010. More than 90 percent of those donations went to Republicans, including House and Senate leadership and the chairs of the HHS oversight committee.

“A lot of commercials that we’ve seen run on television about smoking cessation are targeting children and are run during school hours,” said Rep. Murry. “That’s illogical. So we want to make sure we’re spending our money wisely, at the local level, from the ground up with health departments.”

This past year, North Carolina’s youth smoking rate sank to historic lows.

“We’re very careful about buys,” said Ann Staples, who coordinates media purchases for the Department of Health and Human Services. “The teen prevention ads run druing programs that teens watch and during times when teens are available.”

Staples also said the Department contracts with Channel 1, a school-based TV network.

“Compared to broadcast TV, it’s cheap and it’s great for reaching that specific school audience,” Staples said. “We’re getting ready to do a placement this month in PG and PG-13 movies… and a lot of teenagers go to movies when school is out.”

North Carolina has six major media markets, where costs for buying advertising time can be expensive. Staples worried that county-based money wouldn’t be enough to make media buys in big markets that broadcast into smaller counties.

“Most of the kids are getting their media from online and network and cable TV and from whatever teen radio station they listen to that are probably not based in small towns,” she said.

Main page image courtesy Government and Heritage Library, State Library of NC, via Flickr Creative Commons

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