Nicotine & Tobacco Research, Volume 16, Number 5 (May 2014)
Society News
News Committee for the Society for Research on Nicotine and Tobacco Treatment Network: Policy Issues Michele L. Pergadia PhD1, Karen L. Cropsey PsyD2, Ariadna Forray MD3, Jolomi T. Ikomi MD3, Erica N. Peters PhD3,4, Robert West PhD5 1Department of Psychiatry, Washington University School of Medicine, St. Louis, MO; 2Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL; 3Department of Psychiatry, Yale School of Medicine, New Haven, CT; 4Social Research Center, Friends Research Institute, Baltimore, MD; 5Department of Epidemiology and Public Health, University College London, London, UK
Corresponding Author: Michele L. Pergadia, PhD, Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid, Campus Box 8134, St. Louis, MO 63110, USA. Telephone: 314-286-2270; Fax: 314-286-2213; E-mail: pergadim@ psychiatry.wustl.edu
Recent Policy-Related Tobacco Treatment Issues Tobacco control policies, including excise and sales tax, smoking bans, and public health campaigns, have had an important influence on reducing rates of tobacco use (Wilson et al., 2012). There is also some evidence that those engaged in smoking cessation treatment have improved response rates within the context of such polices (Schillo et al., 2012), which is an interesting finding in need of additional research. Two relatively new tobacco-related policy items in United States are also likely to have evolving implications for tobacco treatment efforts. The first includes the Family Smoking Prevention and Tobacco Control Act (TCA, U.S. Government, 2009), which was passed in 2009. The TCA gave the U.S. Food and Drug Administration (FDA) the authority to regulate tobacco products. The scope of the FDA’s regulation is through evaluation of effects of tobacco products at the population level and includes regulation of how tobacco products are produced, advertised, and sold, and supports related research and education, but does not include regulating tobacco under the FDA’s drug or device provisions (Husten & Deyton, 2013). Thus, to the extent that a product is defined as a tobacco product, it will be regulated under the terms of the TCA, but if the tobacco product is marketed for therapeutic indications, then it would fall under regulations issued by the FDA as a drug or device (Husten & Deyton, 2013). E-cigarettes are an example of a product, in which scope of regulation remains to be determined by the FDA, which is of great interest to manufacturers. However, this ambiguity may create some confusion for consumers and clinicians, in addition to raising questions about how to define the scope of research being conducted in this area, that is, regulatory (Centers for Disease Control and Prevention, 2013) or therapeutic (Bullen et al., 2013). The Affordable Care Act (U.S. Department of Health & Human Services, 2014; U.S. Government, 2010) is a second recent policy issue widely discussed in the media, which has the goal of providing different health care options to all Americans, particularly for millions who are uninsured. The law was signed in 2010 and includes smoking cessation treatment as a covered
benefit under its preventive services (U.S. Department of Health & Human Services, 2014; U.S. Government, 2010). Whether the expanded health care coverage is handled by broadening state services or through a federal exchange currently varies by state (American Lung Association, 2012; U.S. Department of Health & Human Services, 2014). The new Health Insurance Marketplace became available in October 2013, with coverage beginning in January 2014 and open enrollment closing in March 2014 (U.S. Department of Health & Human Services, 2014). There are at least two complexities associated with the implementation of the law and its potential effects on tobacco cessation treatment. Although many new enrollees who were uninsured are likely to be smokers (Pleis, Lucas, & Ward, 2009) and could benefit from tobacco cessation services, smokers are reportedly being charged much higher premiums on the market exchanges (Brill, 2013). Rates under the Affordable Care Act can reach up to 50% higher for smokers than nonsmokers (U.S. Government, 2010). Although it remains to be studied, this higher premium could discourage smokers from enrolling or to potentially claim nonsmoking status. Thus, paradoxically smokers may lose out on the anticipated tobacco cessation benefits. Also the level of tobacco cessation treatment to be provided through the health insurance exchanges will be decided state by state (American Lung Association, 2012). Thus, effective comprehensive tobacco cessation treatment (Fiore et al., 2008) may still remain elusive to some newly enrolled smokers. Further research on the impact of these policies on tobacco treatment and outcomes may inform these emerging areas of regulatory science and health care reform.
Declaration of Interests None declared.
References American Lung Association. (2012). Helping smokers quit: tobacco cessation coverage 2012. Retrieved from www.
doi:10.1093/ntr/ntu030 Advance Access publication March 14, 2014 © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: [email protected].
Downloaded from http://ntr.oxfordjournals.org/ at Western Oregon University on May 22, 2015
Received February 3, 2014; accepted February 5, 2014
Nicotine & Tobacco Research Pleis, J. R., Lucas, J. W., & Ward, B. W. (2009). Summary health statistics for U.S. adults: National Health Interview Survey, 2008. Vital and Health Statistics, 10, 68. Schillo, B. A., Keller, P. A., Betzner, A. E., Greenseid, L., Christenson, M., & Luxenberg, M. G. (2012). Minnesota’s smokefree policies: Impact on cessation program participants. American Journal of Preventive Medicine, 43, S171– S178. doi:10.1016/j.amepre.2012.07.028 U.S. Department of Health & Human Services. (2014). HHS. gov/HealthCare. Retrieved from www.hhs.gov/healthcare/ index.html U.S. Government. (2009). Family smoking prevention and tobacco control and federal retirement reform. Public Law 111–31. Retrieved from http://frwebgate.access. gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_public_ laws&docid=f:publ031.111.pdf U.S. Government. (2010). Patient protection and affordable care act of 2010. Public Law 111–148. Retrieved from http:// www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW111publ148.pdf Wilson, L. M., Avila Tang, E., Chander, G., Hutton, H. E., Odelola, O. A., Elf, J. L., . . . Apelberg, B. J. (2012). Impact of tobacco control interventions on smoking initiation, cessation, and prevalence: A systematic review. Journal of Environmental and Public Health, 2012, 961724. doi:10.1155/2012/961724
Downloaded from http://ntr.oxfordjournals.org/ at Western Oregon University on May 22, 2015
lung.org/assets/documents/publications/smoking-cessation/ helping-smokers-quit-2012.pdf Brill, S. (2013, October 9). How the affordable care act takes aim at smokers. The News Tribune. Retrieved from www. thenewstribune.com/2013/10/09/2828742/how-the-affordable-care-act-takes.html Bullen, C., Howe, C., Laugesen, M., McRobbie, H., Parag, V., Williman, J., & Walker, N. (2013). Electronic cigarettes for smoking cessation: A randomised controlled trial. Lancet, 382, 1629–1637. doi:10.1016/ S0140-6736(13)61842–5 Centers for Disease Control and Prevention. (2013). Notes from the field: electronic cigarette use among middle and high school students - United States, 2011–2012. MMWR Morbidity and Mortality Weekly Report, 62, 729–730. Fiore, M. C., Jaen, C. R., Baker, T. B., Bailey, W. C., Benowitz, N. L., & Curry, S. J. (2008). Treating tobacco use and dependence: 2008 update. Clinical practice guideline. Rockville, MD: US Department of Health and Human Services, Public Health Service. Husten, C. G., & Deyton, L. R. (2013). Understanding the Tobacco Control Act: Efforts by the US Food and Drug Administration to make tobacco-related morbidity and mortality part of the USA’s past, not its future. Lancet, 381, 1570–1580. doi:10.1016/S0140-6736(13)60735–7
Society News
News Committee for the Society for Research on Nicotine and Tobacco Treatment Network: Policy Issues Michele L. Pergadia PhD1, Karen L. Cropsey PsyD2, Ariadna Forray MD3, Jolomi T. Ikomi MD3, Erica N. Peters PhD3,4, Robert West PhD5 1Department of Psychiatry, Washington University School of Medicine, St. Louis, MO; 2Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL; 3Department of Psychiatry, Yale School of Medicine, New Haven, CT; 4Social Research Center, Friends Research Institute, Baltimore, MD; 5Department of Epidemiology and Public Health, University College London, London, UK
Corresponding Author: Michele L. Pergadia, PhD, Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid, Campus Box 8134, St. Louis, MO 63110, USA. Telephone: 314-286-2270; Fax: 314-286-2213; E-mail: pergadim@ psychiatry.wustl.edu
Recent Policy-Related Tobacco Treatment Issues Tobacco control policies, including excise and sales tax, smoking bans, and public health campaigns, have had an important influence on reducing rates of tobacco use (Wilson et al., 2012). There is also some evidence that those engaged in smoking cessation treatment have improved response rates within the context of such polices (Schillo et al., 2012), which is an interesting finding in need of additional research. Two relatively new tobacco-related policy items in United States are also likely to have evolving implications for tobacco treatment efforts. The first includes the Family Smoking Prevention and Tobacco Control Act (TCA, U.S. Government, 2009), which was passed in 2009. The TCA gave the U.S. Food and Drug Administration (FDA) the authority to regulate tobacco products. The scope of the FDA’s regulation is through evaluation of effects of tobacco products at the population level and includes regulation of how tobacco products are produced, advertised, and sold, and supports related research and education, but does not include regulating tobacco under the FDA’s drug or device provisions (Husten & Deyton, 2013). Thus, to the extent that a product is defined as a tobacco product, it will be regulated under the terms of the TCA, but if the tobacco product is marketed for therapeutic indications, then it would fall under regulations issued by the FDA as a drug or device (Husten & Deyton, 2013). E-cigarettes are an example of a product, in which scope of regulation remains to be determined by the FDA, which is of great interest to manufacturers. However, this ambiguity may create some confusion for consumers and clinicians, in addition to raising questions about how to define the scope of research being conducted in this area, that is, regulatory (Centers for Disease Control and Prevention, 2013) or therapeutic (Bullen et al., 2013). The Affordable Care Act (U.S. Department of Health & Human Services, 2014; U.S. Government, 2010) is a second recent policy issue widely discussed in the media, which has the goal of providing different health care options to all Americans, particularly for millions who are uninsured. The law was signed in 2010 and includes smoking cessation treatment as a covered
benefit under its preventive services (U.S. Department of Health & Human Services, 2014; U.S. Government, 2010). Whether the expanded health care coverage is handled by broadening state services or through a federal exchange currently varies by state (American Lung Association, 2012; U.S. Department of Health & Human Services, 2014). The new Health Insurance Marketplace became available in October 2013, with coverage beginning in January 2014 and open enrollment closing in March 2014 (U.S. Department of Health & Human Services, 2014). There are at least two complexities associated with the implementation of the law and its potential effects on tobacco cessation treatment. Although many new enrollees who were uninsured are likely to be smokers (Pleis, Lucas, & Ward, 2009) and could benefit from tobacco cessation services, smokers are reportedly being charged much higher premiums on the market exchanges (Brill, 2013). Rates under the Affordable Care Act can reach up to 50% higher for smokers than nonsmokers (U.S. Government, 2010). Although it remains to be studied, this higher premium could discourage smokers from enrolling or to potentially claim nonsmoking status. Thus, paradoxically smokers may lose out on the anticipated tobacco cessation benefits. Also the level of tobacco cessation treatment to be provided through the health insurance exchanges will be decided state by state (American Lung Association, 2012). Thus, effective comprehensive tobacco cessation treatment (Fiore et al., 2008) may still remain elusive to some newly enrolled smokers. Further research on the impact of these policies on tobacco treatment and outcomes may inform these emerging areas of regulatory science and health care reform.
Declaration of Interests None declared.
References American Lung Association. (2012). Helping smokers quit: tobacco cessation coverage 2012. Retrieved from www.
doi:10.1093/ntr/ntu030 Advance Access publication March 14, 2014 © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: [email protected].
Downloaded from http://ntr.oxfordjournals.org/ at Western Oregon University on May 22, 2015
Received February 3, 2014; accepted February 5, 2014
Nicotine & Tobacco Research Pleis, J. R., Lucas, J. W., & Ward, B. W. (2009). Summary health statistics for U.S. adults: National Health Interview Survey, 2008. Vital and Health Statistics, 10, 68. Schillo, B. A., Keller, P. A., Betzner, A. E., Greenseid, L., Christenson, M., & Luxenberg, M. G. (2012). Minnesota’s smokefree policies: Impact on cessation program participants. American Journal of Preventive Medicine, 43, S171– S178. doi:10.1016/j.amepre.2012.07.028 U.S. Department of Health & Human Services. (2014). HHS. gov/HealthCare. Retrieved from www.hhs.gov/healthcare/ index.html U.S. Government. (2009). Family smoking prevention and tobacco control and federal retirement reform. Public Law 111–31. Retrieved from http://frwebgate.access. gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_public_ laws&docid=f:publ031.111.pdf U.S. Government. (2010). Patient protection and affordable care act of 2010. Public Law 111–148. Retrieved from http:// www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW111publ148.pdf Wilson, L. M., Avila Tang, E., Chander, G., Hutton, H. E., Odelola, O. A., Elf, J. L., . . . Apelberg, B. J. (2012). Impact of tobacco control interventions on smoking initiation, cessation, and prevalence: A systematic review. Journal of Environmental and Public Health, 2012, 961724. doi:10.1155/2012/961724
Downloaded from http://ntr.oxfordjournals.org/ at Western Oregon University on May 22, 2015
lung.org/assets/documents/publications/smoking-cessation/ helping-smokers-quit-2012.pdf Brill, S. (2013, October 9). How the affordable care act takes aim at smokers. The News Tribune. Retrieved from www. thenewstribune.com/2013/10/09/2828742/how-the-affordable-care-act-takes.html Bullen, C., Howe, C., Laugesen, M., McRobbie, H., Parag, V., Williman, J., & Walker, N. (2013). Electronic cigarettes for smoking cessation: A randomised controlled trial. Lancet, 382, 1629–1637. doi:10.1016/ S0140-6736(13)61842–5 Centers for Disease Control and Prevention. (2013). Notes from the field: electronic cigarette use among middle and high school students - United States, 2011–2012. MMWR Morbidity and Mortality Weekly Report, 62, 729–730. Fiore, M. C., Jaen, C. R., Baker, T. B., Bailey, W. C., Benowitz, N. L., & Curry, S. J. (2008). Treating tobacco use and dependence: 2008 update. Clinical practice guideline. Rockville, MD: US Department of Health and Human Services, Public Health Service. Husten, C. G., & Deyton, L. R. (2013). Understanding the Tobacco Control Act: Efforts by the US Food and Drug Administration to make tobacco-related morbidity and mortality part of the USA’s past, not its future. Lancet, 381, 1570–1580. doi:10.1016/S0140-6736(13)60735–7
