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Tuesday, September 25, 2012

Disparities in Tobacco Use

The national survey on tobacco use recently published in the American Journal of Public Health shows that tobacco use remains high among U.S. adults and use varies greatly among populations and geographic regions. The study found that 19.3% of adults smoke cigarettes and one in four adults use tobacco products.  Use of other tobacco products, although dwarfed by cigarette use, may also be increasing. This increase threatens the gains made in curbing tobacco use through cigarette tax policy, aggressive anti-smoking media campaigns, smoke-free air policies, and access to tobacco cessation services.

Tobacco products, such as chewing tobacco, snuff, cigars and cigarillos, and pipes, still cause negative health consequences, but are often overshadowed by efforts to reduce smoking. By including other tobacco products in the survey, there was a noteworthy expansion in how researchers view the tobacco epidemic and highlights the need for public health strategies to include these products in tobacco control efforts.

Patterns of tobacco use were uncovered by categorizing 118,581 respondents by gender, age, race/ethnicity, educational attainment, annual household income, and sexual orientation. Kentucky had the highest rate of tobacco use (37.4% of adults) while Utah had the lowest (14.1% of adults). Men smoke much more than women, and two-thirds of adults identifying as ‘non-Hispanic other’ reported using any tobacco product. This study is also the first national assessment of tobacco use in the Lesbian, Gay, Bisexual and Transgender community (LGBT). Tobacco use among LGBT individuals is 38.5%, compared to 25.3% among heterosexual respondents.

The study underscores the importance of addressing disparities in tobacco use to effectively implement tobacco control programs.  All at-risk populations should be represented in evidence-based studies and they must have access to cessation programs and services. By focusing on the populations and regions with the highest use, we can work toward truly comprehensive policy and system changes to ensure a tobacco-free future for all Americans.


Posted by: Alyson Hazen Kristensen at 12:00 AM
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Wednesday, September 12, 2012

The Case of the Missing Prevention

The Institute of Medicine’s (IOM) new report, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, includes the issue of missed prevention opportunities, which resulted in $55 billion dollars in excess costs in 2009. This small, but important, segment of waste shows that prevention is not being integrated into health care as well as it could be.

Missed opportunities to deliver primary and secondary preventive services lead to waste and excess cost in multiple ways. When people miss screening tests, diseases or infections are not detected early when they are more easily treatable. More extensive care is usually required later when they are sicker. When people are not counseled, they fail to receive advice and support to stop smoking, reduce alcohol consumption, engage in safer sex, or lose weight. And when people do not receive necessary vaccinations, they place themselves at risk of contracting an illness that could lead them to the doctor’s office or hospital for treatment.

Tertiary prevention also plays a role in excess spending. Ill patients, particularly those chronically ill, may require long-term care and rehabilitation. Interventions such as disease management, self-care training, and care coordination help patients manage their illness and stay out of the hospital. Unfortunately, these interventions are implemented too infrequently.

The IOM report highlights an important issue. Although a small part of excessive health care spending, it shows that our health care system has room to improve in emphasizing prevention. Partnership for Prevention has long advocated for a prevention-focused health system and delivery of high-value preventive services, such as those identified by the National Commission on Prevention Priorities ( Healthcare providers must not only provide preventive services to patients but also work together on their patients’ behalf, imploring them to promote their own health. The health care system could save the nation billions of dollars annually in unnecessary costs, and save lives, by joining hands and promoting prevention.

Posted by: Alyson Hazen Kristensen at 12:00 AM
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Labels: costs, healthcare, prevention, preventiveservices