"The Health Benefits of Health Reform - Part 2" by John Auerbach

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I have already suggested a direct link between reform and the rise in adult flu vaccinations and colonoscopies in 2007. But now there is evidence that health care reform also contributed to the dramatic news that adult smoking rates in Massachusetts plummeted in the first year that the new law went into effect. The Massachusetts Department of Public Health made a major announcement last week when we released data showing that adult smoking rates in Massachusetts have dropped almost 8% in 2007 when compared with 2006. This represented the largest drop in a decade and was especially remarkable because it represented a reduction that was 4 times the rate of the reduction in the previous year.

People give up smoking for a variety of reasons. Sometime it is related to cost. For example, just since the Governor and Legislature increased the tax on cigarettes in Massachusetts on July 1, 2008, we have found that calls to our Quit Line increased by 2000 percent - that's 20 times the number of calls we were accustomed to receiving. But while cost is a factor, most of the time adults try to give up smoking because they are worried about the deadly and disabling consequences of smoking.

Even though most of our residents knew about those risks when they started smoking, something external can trigger the decision to finally make the effort to give up this bad habit. Numerous evaluations have shown that public health interventions - from media campaigns to peer-based educational activities to the circulation of the latest risk information - can make a difference. And we did have $4.5 million in new tobacco control funding in 2007 thanks to Governor Patrick and the Legislature.

But we also know that many people attribute the decision to stop smoking to the efforts of their primary care doctors and nurses. These clinicians routinely screen their patients to determine who smokes and invariably counsel their patients about the importance of giving up the habit. When needed and appropriate, primary care doctors prescribe nicotine replacement therapy - patches or gum - to help their patients overcome the physical urges. (Guidelines for clinicians on this issue are available here ) And in 2007, when more than a third of a million previously uninsured residents received health insurance as a result of health care reform, many were able to get a physical or see a primary care doctor for the first time in years. At those clinical visits tens of thousands, if not hundreds of thousands, of them heard a health authority say - "you need to give up those cigarettes NOW to prevent serious harm to your health". The statistics we released last week indicate that a lot of them listened.

One final and related point, an additional benefit of health care reform was that it mandated that MassHealth members receive a tobacco cessation benefit in 2007 - coverage for both nicotine replacement and counseling. As an indication that this helped, we noted that the new cessation benefit was used by a high percentage of recipients and that the rate of decline in smoking prevalence among MassHealth members was higher in 2007 than the rate of decline among the general population.

John Auerbach
Commissioner, Massachusetts Department of Public Health

This program aired on August 4, 2008. The audio for this program is not available.