Research indicates that significant reductions in morbidity and
mortality can be realized when people who use tobacco are
successful in quitting. However, nicotine is an addictive
substance. It is very challenging to change tobacco use behavior
and to overcome this addiction. Only about 3 % of smokers per
year are able to quit permanently. Behavioral change is a
process that occurs over time; it is not a single event. No
single intervention will alter a person's tobacco use. As with
other types of addictions, the treatment of nicotine addiction is
characterized by relapse.
Even accounting for relapses, tobacco cessation programs are more
cost-effective in significantly reducing morbidity and mortality
among the population than many other clinical prevention services
including hypertension and colon cancer screenings. Unlike many
other clinical prevention services which are targeted at the
adult population, nicotine treatment (tobacco cessation) programs
can be directed at all age groups.50 Limited information exists
on adolescent nicotine treatment programs.51 However, the
Prevention Research Center of West Virginia University is
currently evaluating a promising adolescent treatment program.
Studies indicate that physicians have a significant effect on
patients' decision to quit smoking.52 For many adults nicotine
replacement therapies (NRT) or other pharmaceutical interventions
increase the success rates for quitting, especially when combined
with other interventions such as counseling.53
By including activities which will impact on the availability of,
access to, and utilization of nicotine treatment as part of the
comprehensive tobacco program, DHSS will move toward lowering the
rate of tobacco use in New Jersey. According to the CDC,
treatment (cessation) programs will show greater short-term
public health benefits than any other component of a
This component will be used to address the following goal and
|Goal 3: || To increase
the number of youth and adult tobacco users who initiate
- Increase the number of
organizations offering nicotine treatment programs
- Increase awareness of
the availability of nicotine treatment programs for:
| (a) general population
| (b) high risk sub-
- Increase the number of
individuals accessing nicotine treatment programs
- Current Practices in New Jersey:
Individuals insured through New Jersey's Medicaid program have
coverage for nicotine treatment including nicotine replacement
treatment (NRT). Data on private coverage is not available at
The American Cancer Society offers nicotine addiction treatment
programs through its local chapters. However, there is no
requirement for local chapters to provide this service. In
addition, some local chapters of the American Lung Association
and hospitals offer nicotine addiction treatment programs.
- Best Practices and Other States
This section outlines best practices and other states' approaches
to this program component:
- The CDC recommends that cessation treatment be
incorporated as part of any comprehensive plan.
California, Massachusetts, and other states are including
nicotine addiction treatment (cessation) as part of their
programs. DHSS expects to learn more about their
effectiveness in the future.
- Nicotine addiction treatment should include specific
treatment programs for youth. Florida is using the Not-On
Tobacco Teen Cessation Program from the Prevention Research
Center of West Virginia University.
- The elements of nicotine cessation programs in other
states vary considerably. Features may include: a
clearinghouse, telephone quit line, Medicaid coverage for
NRT when combined with counseling, public/private
collaborations with community-based programs, and insurance
coverage for NRT.
- In 1999 the Agency for Health Care Policy and Research
(AHCPR) will update its Smoking Cessation Clinical Practice
Guideline to include new advances in nicotine treatment
practice and new treatment options.
- PROPOSED APPROACH
This section outlines the proposed approach to implementing the
nicotine treatment component, including selecting the target
population, establishing basic principles, and creating
opportunities for public/private partnerships.
- Target Populations
Nicotine treatment programs will be expected to target both
adolescent and adult smokers.
- Basic Principles:
As the program begins to develop, it is important to incorporate
the following basic principles:
- DHSS should influence policy to increase the availability,
accessibility and utilization of nicotine addiction
treatment in New Jersey including:
- Encouraging coverage of treatment by managed care
organizations and the public sector. This benefit could
be reported in DHSS' HMO "report card."
- Encouraging drug/alcohol treatment centers to treat
nicotine addiction simultaneously with the treatment of
- DHSS will work with the Academy of Medicine, the Academy
of Family Practitioners, the New Jersey Geriatric Education
Center and the Academy of Pediatrics to train physicians
and other health staff through train-the-trainer models to
screen and counsel patients regarding nicotine addiction.
- DHSS will identify organizations where physicians and
others can refer patients if they need additional
assistance to quit.
- After determining the types of treatment programs which
should be offered in New Jersey, community input (community
partnerships) will be used to determine where these
programs should be located.
- Nicotine addiction treatment should be integrated into
other non-medical settings (e.g.: health clubs, vocational
schools, campuses, senior centers).
- Programs must be culturally appropriate for targeted
- Opportunities for Public/Private Partnerships
To increase the availability and awareness of nicotine treatment
programs, the following partnerships may be appropriate:
- Pharmaceutical companies promoting NRT;
- Medical associations (e.g. Academy of Medicine, Academy of
- Community-based organizations; and,
- Non-medical settings.