Docs Roam Legislature Looking for Tobacco-Cessation Funds

With tobacco-cessation funds eliminated from the Senate budget, doctors ask members of the House of Representatives to add prevention funds into their budget.

By Rose Hoban

A small group of white coat-clad doctors worked the hallways of the General Assembly Tuesday, dropping into legislators’ offices and stopping them in hallways.

Drs. (L to R) Adam Goldstein, Mary Sherwin Mouw and Richard Rosen present a letter signed by hundreds of doctors to Rep. Nelson Dollar (R-Apex), who chairs the House Health and Human Services appropriations committee. — Drs. (L to R) Adam Goldstein, Mary Sherwin Mouw and Richard Rosen present a letter signed by hundreds of doctors to Rep. Nelson Dollar (R-Apex) outside his office. Dollar chairs the House Appropriations Committee.

The physicians were in Raleigh to represent hundreds more from around the state who signed onto a letter asking lawmakers to allocate some money for tobacco-cessation funding, an allocation absent from the budgets of both the Senate and Gov. Pat McCrory.

Two years ago, the state allocated about $17 million to fund tobacco-cessation programs in the form of the Quitline, a service available for all ages, and the Tobacco. Reality. Unfiltered., or TRU, program that was in most middle and high schools.

Last year, the state budget cut that down to $2.7 million for tobacco-cessation programs, most of which went to the Quitline. Other prevention dollars allocated were then held back due to Medicaid overruns.

In the Senate budget passed last week, the proposed allocation for the Quitline is $1.4 million, while the amount earmarked for youth prevention is zero.

House budget writers are still crafting their response to the Senate budget, which was passed last week.

“There was no question, the programs were effective,” said Richard Rosen, an oncologist in the Moses Cone Health System in Greensboro. “In both high school and middle school, smoking rates were down by more than 50 percent over the past decade.”

Findings in the last Youth Tobacco Survey, done in 2011, found youth smoking at historic lows in North Carolina, with only 15.5 percent of high school students reporting smoking (down from 27.3 percent in 2003) and 4.2 percent of middle schoolers reporting smoking (down from 9.3 percent in 2003).

“My daughter is in the 11th grade and they had TRU groups in her school, as did most schools around the state,” said UNC family medicine doctor Adam Goldstein. “She said that this year some of her classmates, when she talked about the TRU campaign, said, ‘What’s TRU?’”

He said that in the previous survey, there was an 85 percent recognition of the campaign among high school students.

“The irony, of course, is that the CDC adopted as their national campaign North Carolina’s campaign,” Goldstein said. “The whole ‘Real Stories’ commercials that they’ve put out there nationally now originated in North Carolina.

“So it’s effectiveness has been proven and is used nationally now.”

Millions spent, hundreds of millions saved

Each year, North Carolina receives millions from tobacco companies as part of the 1999 Master Settlement Agreement (MSA); this year, the total will be about $139 million.

Originally, the funds were intended to refund states for Medicaid expenditures related to the long-term effects of smoking – lung cancer and heart and respiratory diseases, among others.

Included in the MSA was a restriction on tobacco marketing to youth, but anti-tobacco campaigners maintain the companies’ advertising power means kids see smoking messages all the time.

“You’re facing an industry marketing budget of $396 million annually, just in North Carolina,” said Pam Seamans, head of the N.C. Alliance for Health. “What we’ve spent in tobacco prevention is a drop in the bucket that we have to counteract all those marketing messages that young people are susceptible to.”

She said she frequently encounters lawmakers who ask who, by now, doesn’t know that smoking is bad for you.

“We have 100,000 new sixth-graders every year who do need to be given some form of education about the dangers of smoking,” Seamans said. “The fact of the matter is that it’s these 100,000 new sixth-graders that may or may not know. Some come from families where they may have gotten those messages, but others may not have.”

The doctors who came to Raleigh on Tuesday said that it’s important to intervene before young people begin smoking, because it’s so hard to quite once they’ve begun – and the younger they start, the harder it is.

“We do know that more than half of smokers make a determined effort to quit every year,” Rosen said. “Quitting is often a gradual process and it may take multiple efforts until someone is totally abstinent from then on.”

He said the cardiac benefits of quitting can be seen pretty quickly, but that it can take years for a former smoker’s chance of lung cancer to drop off.

“The Surgeon General’s report on smoking among older adults said it’s never too late to quit,” Goldstein said. He told the story of an 81-year-old patient he referred to the Quitline recently. She had been smoking for more than 50 years.

“If a patient has or hasn’t developed cancer or heart disease, there are still benefits to quitting,” he said. “More important, she was proud; her husband was proud.

“At the end of the appointment, he was walking out of the office and as he passed me, he bumped my elbow and winked at me.

“He was so excited.”

Commercial developed by the TRU campaign. Last year’s NC state budget had a provision prohibiting statewide anti-tobacco media campaigns using state dollars.

Disclosure: NCHN board member Leah Devlin is a signatory on the letter presented by the doctors to legislators. She was not contacted about this story.