Live Healthy State - Smoking Cessation

What we should know and do to drive change:

Issue specific to Secondhand Smoke

There is no safe level of exposure to secondhand smoke (SHS); even brief exposure can cause immediate harm.
Health problems caused by secondhand smoke in adults who do not smoke include coronary heart disease, stroke, and lung cancer, as well as adverse reproductive health effects in women, including low birth weight.
Secondhand smoke can cause sudden infant death syndrome (SIDS), respiratory infections, ear infections, and asthma attacks in infants and children.
There is no safe level of exposure to secondhand smoke. People who do not smoke who are exposed to secondhand smoke, even for a short time, can suffer harmful health effects.
In adults who do not smoke, secondhand smoke exposure can cause coronary heart disease, stroke, lung cancer, and other diseases. It can also result in premature death.
Secondhand smoke can cause adverse reproductive health effects in women, including low birth weight.
^‍In children, secondhand smoke exposure can cause respiratory infections, ear infections, and asthma attacks. In babies, secondhand smoke can cause sudden infant death syndrome (SIDS).
Since 1964, about 2,500,000 people who did not smoke died from health problems caused by secondhand smoke exposure.
The effects of secondhand smoke exposure on the body are immediate.
^‍Secondhand smoke exposure can produce harmful inflammatory and respiratory effects within 60 minutes of exposure which can last for at least three hours after exposure.

Who is affected most?

Populations that remain more likely to be exposed to secondhand smoke include children ages 3-11; non-Hispanic, people with lower incomes; people with less education; people who like in rental and multi-unit housing; people who live with someone who smokes inside home; and people who work in traditionally blue collar occupations.^‍
Almost two of every five children 3-11 years of age, including over half of non-Hispanic Black children, were exposed to secondhand smoke during 2017- 2018.
During 2017-2018, secondhand smoke exposure among non-Hispanic Black individuals and those living below the poverty level continued to be approximately twice as high compared with non-Hispanic White individuals and those living above the poverty level, respectively.

Solutions

FACT: Twenty-one studies showed that smoke free laws and policies in the workplace were linked to a 3.4% decrease in tobacco prevalence CDC second hand smoke exposure Smoke-free ordinances, including bans in bars and casinos, will decrease the smoking prevalence rate in Louisiana, prevent initiation of smoking among youth, and reduce exposure to secondhand smoke.

The most effective way to provide protection from secondhand smoke are smoke free policies.

Source

Current state of the policy

Currently, only 32.1% of the population is covered, and Louisiana lags behind the nation in its smoke free laws, as 62.3% of the United States population is covered (AHR).

2022

Is my community protected?

2020

Demographics map

Where do I find out more?

Developing Non-smoking Workplace Policy
Current list of smokefree municipalities in Louisiana - ANR
ACCOMPLISHMENTS | Healthier Air for All
American Nonsmokers’ Right Foundation complied the Bridging the Gap Reportthat shares information on the importance of smoke-free policies, current smoke-free protections and which populations are least likely to be protected.
The Louisiana Smoke-Free Air Actprohibits smoking in most public places and workplaces, including all restaurants with or without attached bars.
The Louisiana Tobacco-Free K-12 Schools Actprohibits use of all tobacco products on all K-12 school property, including buses.
The Louisiana Act 211 Smoke-free Policies for Colleges and Universities Statewide prohibits smoking on public post-secondary education campuses.
Smoke-Free Public Housing Guideis for housing agency directors and property managers on the Geaux Smoke-Free Housing Process.
The HUD Smoke-Free Housing Guidebookprovides a roadmap to public housing agencies for adopting, implementing, and maintaining smoke-free housing policies.
CDC Healthy Homes Informationhighlights the dangers of secondhand smoke exposure in homes and provides resources for smoking cessation and secondhand smoke prevention.
American Nonsmokers’ Right Foundation complied the Bridging the GapReport that shares information on the importance of smoke-free policies, current smoke-free protections and which populations are least likely to be protected.

Issue specific to Smoking Cessation

Smoking is one of the leading causes of preventable deaths in Louisiana (CDC).

As of 2022, almost 20% of adults in Louisiana continue to smoke. A 6% decrease is required to meet the national average (AHR).

Adult cigarette smokers. Adult prevalence is highest among Louisianians who earn less than $49,000 (AHR).

Who is affected most?

Explore Smoking in Louisiana | 2022 Annual | AHR (americashealthrankings.org)

Earn less than $49,000 (AHR)
Identify as multiracial (24%)
Less than high school education (37% prevalence)
Under age 64
Men
Live in rural communities
The Medicaid populations smokes almost at a rate of about 2.5 times higher than the private insurance population (American Lung Association).

In my community

PLACES, a collaboration between CDC, the Robert Wood Johnson Foundation, and the CDC Foundation, provides health data for small areas across the country. This allows local health departments and jurisdictions, regardless of population size and rurality, to better understand the burden and geographic distribution of health measures in their areas and assist them in planning public health interventions.

PLACES provides model-based, population-level analysis and community estimates of health measures to all counties, places (incorporated and census designated places), census tracts, and ZIP Code Tabulation Areas (ZCTAs) across the United States.Learn more about PLACES.
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PLACES - Local data for better health

Solutions

FACT: Expanding Medicaid coverage of smoking cessation programs to include pharmaceutical and counseling for all clients will result in a decrease in the adult smoking prevalence rate in Louisiana.

Research from Denmark found that the “Gold Standard” of cessation treatment that includes individual or group counseling reduced quit rates by 69% for men and 31% for women (BMJ).
Smoking cessation without professional help (counseling/support) is only achieved in 3-5% of smokers (ERS Journals).
Researchers expect that policies to “motivate and assist” Medicaid clients to stop smoking may “yield substantial savings in short-term medical costs” (JAMA).
If 1% of Medicaid clients quit smoking, Louisiana is expected to save $31.7 million in Medicaid costs in the following year (American Lung Association).

Current state of the policy

In 2022, Medicaid in Louisiana only covered individual counseling for pregnant women. (CDC)
Eighteen (18) states cover both individual and group counseling through Medicaid. (CDC)
Medicaid Coverage of Tobacco Cessation Treatment (CDC)
Of GA, AL, MS & FL, only FL covers individual counseling and group counseling varies.
Individual counseling varies in Alabama and Georgia. Group counseling varies inGeorgia.‍
Florida is 14.7%, Georgia is 15%, Alabama is 17.2%, Mississippi is 19.6%.
List of states that cover individual and group counseling:

California (8.9%)
Colorado (12%)
Connecticut (11.1%)
‍Illinois (12%)
Kansas (15.6%)
Kentucky (19.6%)
Maine (15.6%)
Massachusetts (10.6%)
Missouri (17.3%)
New York (12%)
North Dakota (15%)
Ohio (18%)
Oregon (12.4%)
Pennsylvania (14.4%)
Rhode Island (12.4%)
South Carolina (15.5%)
Virginia (12.4%)
Wisconsin (13.3%)

Where do I find out more?

FQHS are required to report (annually) on their “implementation and dissemination of evidence-based tobacco cessation. (Frontiers)
Research has shown that 82% of FQHC patients who smoke want to quit, and about 30% of the total FQHC population are current smokers.
(Journal of Health Care for the Poor Underserved)
The most common barrier to providing smoking cessations services at FQHS is patients lacking insurance coverage. (Journal of Health Care for the Poor and Underserved)
FQHCs face barriers and limitations in offering smoking cessation programming to its population, given the lack of resources and high burden (Preventing Chronic Disease)
Why Won't Our Patients Stop Smoking? - PMC (nih.gov)New Studies Probe “Who Smokes and Why” to Bolster U.S. Prevention Efforts | PRB
How similar states reimburse for cessation counseling
Pharmacy Guidance: Age Requirements for FDA-Approved Smoking Cessation Medications (PDF)
The NYS and NYC Health Commissioners' Letter to Providers (PDF)
Smoking Cessation Medication Prescribing Chart, Instructions and FAQs (PDF)
New York State (NYS) Smoking Cessation Counseling Information and BillingCodes (PDF)
Billing Guide for Tobacco and E-Cigarettes Screening and Counseling for New York State (PDF)
Additional Information and Resources for Healthcare Providers

Issue specific to Vaping

Youth use of tobacco products, including e-cigarettes, is unsafe (CDC).
E-cigarettes is the most used tobacco productamong U.S. youth (CDC).
USDA and CDC found that 2.55 million U.S. middleand high school students reported e-cigarette use in past-30 days (CDC).
The COVID pandemic resulted in a decrease in the peak number of U.S. youth whoreport e-cigarette use, but current users report more intense use leading to severe nicotine addiction (CNC).
Research shows that most youth are unaware that most e-cigarettes contain nicotine (Drug and Alcohol Dependence).
Reducing Vaping Among Youth and Young Adults (SAMHSA).

LA|US Rates:
LA Rate: 22.9% Amongst high school students. 15.4% amongst middle schools.
US Rate: 32.7% Amongst high school students.
(AHR)

Who is affected most?

In the United States:
‍
‍Among U.S youth, E-cigarettes are the most used tobacco product (CDC).

USDA andCDC found that 2.55 million U.S. middle and high school students reported e-cigarette use in past-30 days (CDC).

Between2017 and 2018, e-cigarette use increased 78% among high school students and 48%among middle school student (Public Health Reports).

The COVID pandemic resulted in a decrease in the peak number of U.S. youth who report e-cigarette use, but current users report more intense use leading to “severe nicotine addiction” (CNN).

According to research, (Drug and Alcohol Dependence), most youth are unaware that most e-cigarettes contain nicotine.

Fruit-flavored vapes appear to the youth as the most popular flavor, among youth who report e-cigarette use, 84.9% use flavored products (CDC).
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In Louisiana, 1 in 3 high school students use e-cigarettes.

White students were 2 times more likely to use e-cigarettes when compared to black high school students (40% of white compared to 21% black students).

Black high school students were 1.5 time more likely to use cigars/cigarillos and hookahs when compared to white students. (Cigars/Cigarillos: 18% of black students compared to 12% of white students; Hookah: 11% of black students compared to 7% of white students).

High school students were 3 times more likely to accept a cigarette from a friend when compared to middle school students (MS: 3% and HS: 8%). (wellaheadla.com)

2023

Demographics map

Solutions

FACT: CATCH My Breath program designed to prevent e-cigarette use among 5th-12th graders has been shown to significantly reduce the likelihood of e-cigarette use among students who complete the program (Public Health Reports).

Research has shown that use of the CATCH My Breath curriculum resulted in 1) reductions in nicotine vaping use, 2) increases in nicotine vaping knowledge, 3) increases in positive perceptions of vape-free living, and 4) reductions in overall tobacco use.

CATCH My Breath is bases on the “psychosocial determinants of e-cigarette susceptibility, initiation, and sustain use,” and its implementation in middle schools lowered e-cigarette use among the target population (Public Health Reports).

Current state of the policy

FACT: Among youth who report e-cigarette use, 84.9%use flavored products, with “fruit” being the most popular flavor (CDC).

In December 2019, Congress passed theTobacco legislation that raised the federal minimum age able to purchase tobacco products from 18 to 21, including e-cigarettes.

24 states and the District of Columbia have enacted policies. Louisiana is one of these states.

Nine states have banned flavored e-cigarettes, as these have a huge draw to adolescent e-cigarette use. Louisiana is not one of these, but hopefully will work towards passing this in the future.

Read more:Regulating Vaping — Policies, Possibilities, and Perils
E-cigarette fact sheet: https://www.cdc.gov/statesystem/factsheets/ecigarette/ECigarette.html

Current state of programs

FACT: 6 Texas schools that applied the Catch My Breath intervention showed that increases in e-cigarette use were significantly lower in intervention schools (2.8%-4.9%) than the 6 control schools who did not provide the intervention (2.7%-8.9%). (PHR)
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Intervention schools had significantly greater improvements in e-cigarette knowledge (β = 0.71; 95% confidence interval [CI], 0.21-1.21; P= .008) and perceived positive outcomes (β = –0.12; 95% CI, –0.23 to –0.02;P= .02) than control schools). (PHR)

Catch My Breath is a cost-free program that operates on the bases of “psychosocial determinants of e-cigarette susceptibility, initiation, and sustain use,” and its implementation in middle schools. (Public Health Reports)

Catch My Breath has not been utilized in Louisiana middle and high schools. Next steps include researching Catch My Breath utilization in Louisiana middle and high schools, mapping all vaping curriculums being used in Louisiana middle and high schools, and Developing action plan on how to 1) train teachers and educators on Catch My Breath curriculum, and 2) work with school superintendents to mandate use of program in all Louisiana middle and high schools.

Catch My Breath is the only evidence-based youth nicotine vaping prevention program for grades 5-12 that has been proven to substantially reduce students’ likelihood of vaping. The vape education program’s effectiveness was published in a peer-reviewed journal and the program is listed in SAMHSA’s Evidence-BasedResource Guide Series. (Catch My Breath)

Where do I find out more?

Priority Area: Smoking Cessation

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