Susan M. Zbikowski, PHD, Senior Vice President, Research, Training, & Evaluation 

I am pleased to announce that Alere Wellbeing had an important paper published this month in the Journal of Environmental and Public Health. Our article, “The 2009 US Federal Cigarette Tax Increase and Quitline Utilization in 16 States,” written by Terry Bush, Susan Zbikowski, Lisa Mahoney, Mona Deprey, Paul D. Mowery, and Brooke Magnusson, describes call volumes to 16 state quitlines, characteristics of callers, and cessation outcomes before and after the 2009 federal tax increase.

You may remember back to 2009 when smokers were once again hit with a large increase in the cost of their cigarettes. On February 4, 2009, the federal government enacted a 62-cent increase in the federal cigarette tax, along with increases in other tobacco taxes, to fund expansion of the State Children’s Health Insurance Program. The federal cigarette tax increased to $1.01 per pack on April 1, 2009. Right before the increase in cigarette tax was made public, tobacco companies sneaked in their own price increase on tobacco products. This dramatic increase in the costs of smoking was likely to be a tipping point for smokers to try to quit. With support from the Centers for Disease Control and Prevention (CDC), researchers at Alere Wellbeing decided to find out if these increased costs would result in more people calling state quitlines for help.

Results of this study were just released in the Journal of Environmental and Public Health. The study showed that the federal excise tax on cigarettes was associated with a 23.5% increase in calls to quitlines and attracted somewhat different types of smokers compared with the year before the tax. In particular, it seems that the tax had a greater impact on those who had less education and who were living with other smokers based on the increase in calls from this demographic. Although we also expected that more young smokers would call, this was not the case in this study.

Another important finding from the study was that quit rates among those who called after the tax increase did not differ from quit rates among those who called before the tax increase. The lack of a significant increase in quit rates is not surprising since the participating quitlines did not provide additional or different services to callers. Nonetheless, increasing the number of callers at the same quit rate means an increase in total number of successful quitters. In these 16 states, of the 19,911 additional tobacco users who called during the time of the tax an additional 5,714 would quit smoking (19,911 more callers after tax ∗ 28.7% quit rate).

If the money raised from increased taxation on cigarettes was put into cessation treatment, then it is likely the taxes would have an even greater effect on helping smokers to quit. Numerous studies have shown that quitlines increase ones chances for quitting, especially when multiple counseling calls plus nicotine replacement medications are made available. Unfortunately, states have been cutting back on the services they provide on order to contain costs. This study from Alere Wellbeing provides important data relevant to public health policy on tobacco control. Providing evidence-based cessation services combined with tax and price increases, smoke-free laws, anti-tobacco advertising, and bans on promoting tobacco use can increase quit rates and decrease the prevalence of tobacco use.

Reed Dunn, Senior Recruitment Marketing Manager

Every year on May 31, the World Health Organization celebrates World No Tobacco Day (WNTD). Established in 1987, WNTD is an annual recognition of global efforts against tobacco use. The theme of World No Tobacco Day 2012 is “tobacco industry interference.” WHO is urging countries to put the fight against the tobacco industry at the heart of its efforts to control the global tobacco epidemic.

In response, Alere Wellbeing plans to come together as one company on Thursday, May 31 to conduct at least 3,000 live tobacco interventions - helping at least 3,000 of the tobacco industry’s customers get one step closer to overcoming their deadly addiction for good. We will also be setting a new record for the number of tobacco users receiving support from the Quit For Life® Program in a single day.

We encourage tobacco users who are ready to quit to join the movement and call 1-866-QUIT-4-LIFE (1-866-784-8454) on Thursday, May 31, 2012.

For more information, please read the following press release.

Reed's drive to live a better life started when he joined the Alere Wellbeing team. As senior recruitment marketing manager, he works to educate eligible populations of the benefits available to them to achieve a healthier lifestyle. Read more blog posts by Reed Dunn.

Visit www.alerewellbeing.com to learn about Alere Wellbeing’s Quit For Life® Program, the only commercial tobacco cessation program in the U.S. with proof of effectiveness published in multiple peer-reviewed scientific journals over the course of 25 years.

Allegra Wiborg, Lead Trainer, Service Delivery

Some people might think that the Quit For Life® Program helps a person quit tobacco. And they’d be half right. But really, we’re all about helping people quit tobacco, and stay quit.

In my last couple posts I’ve written about strategies and mind-sets Quit Coaches can help a participant cultivate to quit successfully. But, as I used to tell participants, “Quitting is half the battle” (only the callers born in the late ‘70s to early ‘80s picked up on the subtle G.I. Joe reference—but it’s a good analogy all the same) “staying quit is the other half.”

So if a participant has already quit and is feeling great, does he still need a Quit Coach? Think about it this way: becoming good at something takes time, whether it’s skiing, meditating, or living a tobacco-free life. Challenges creep up: hills that are steeper looking down than they seemed looking up, distracting voices in the other room, or a buddy accidently offering a cigarette to his newly quit friend. And when challenges arise—especially unplanned challenges—people often stumble.

That’s why Quit Coaches are trained to assess participants who are quit just as thoroughly as participants who are planning to quit. By “assess” I mean explore strengths and barriers that a person might have toward reaching her goal. And participants can still have challenges even when they are successfully quit: that old pack of cigarettes in the freezer, a family reunion where most members smoke, a bombshell stressful event waiting around the corner. Coaches ask questions to uncover information that participants might not even be aware of as a potential challenge to staying quit. Coaches can then present any concerns they have to the participant in order to build not a quit plan, but a stay quit plan.

Andy Roberts, the Quit For Life® Quality Director of Service Delivery, explains why speaking to a Quit Coach is still important for the participant who is quit—even if the participant feels he’s doing great.

Imagine you went to the doctor for a serious health issue; the doctor examined you, took some tests, gave you medicine, and then sent you on your way. When you came back for a follow-up appointment the doctor asked, “How are you feeling?” and you responded, “I’m not feeling symptoms right now.” Would you expect the doctor to say, “Okay, I take your word for it—bye,” or would you expect the doctor to say, “That’s great, now I’m going to examine you again to make sure that the issue has cleared.”

I would feel more comfortable working with the second doctor to better my health. I mean, even if I felt better, I’d like to have the sign off of a professional.

Each step in the quitting process has unique obstacles. Staying quit can be the last step, but it’s not an isolated event. It requires a new way of thinking—every minute, every hour, every day.  Staying quit does get easier with time, but it takes practice to develop the skill of living tobacco-free with confidence. Good thing there are professionals to help.

Mark Twain once said, “Quitting smoking is easy. I’ve done it hundreds of times.” Obviously, he never tried the Quit For Life® Program.

As a former Quit Coach®, Allegra remembers the importance of viewing each caller as an individual who brings their past and their personality to the behavior change process. And, she remembers the importance of treating each caller with care. These are elements she tries to share with Quit Coaches in her training classes. Read more of Allegra Wiborg's blog posts.

Learn about the Quit For Life® Program

Read more stories from current and former Quit Coaches

Ken Wassum, Associate Director, Clinical Development & Support

Let’s start this week’s blog with a couple quotes from the American Cancer Society’s 4th Tobacco Atlas that demonstrate how the tobacco industry views teens: 

• “A 1984 R.J. Reynolds document stated that younger adults are the only source of replacement smokers”.
• “It is important to know as much as possible about teenage smoking patterns and attributes. Today’s teenager is tomorrow’s potential regular customer, and the overwhelming majority of smokers first begin to smoke while still in their teens….The smoking patterns of teenagers are particularly important to Philip Morris.” Philip Morris USA, 1981

While these quotes are 20 plus years old, nothing about the actions of the tobacco industry indicates that they have changed their view of teens.  It is important to remember that tobacco advertising does not sell a product – it sells a lifestyle and a look.  The ads are made to appeal to the young because that is when new smokers pick a brand.  Compared to youth, adults are much less likely switch brands.

Cigarette prices and taxes have made cigarettes quite expensive in most higher-income countries, but the same cannot be said in low and middle-income countries (LMIC).  Smoking is much more affordable and the youth of these countries often smoke at much higher rates than the US.  In fact in SE Asia and Western Pacific the rates of smoking exceed 50% compared to 25% in the US.

The 4th edition of the Tobacco Atlas points out that among adults, men are more likely to smoke than women, and in many countries there are ten times more men than women smokers. This is not the case with today’s teens and the difference in smoking rates between girls and boys is small.  In fact, more girls smoke than boys in at least 25 countries.  These teens are precious market-share to the tobacco industry.

In most high income countries there are many restrictions on tobacco advertising.  In many low- to middle-income countries, such as Indonesia, this is not the case. Tobacco ads can be placed in close proximity to schools and outdoor ad

vertising is common.  The streets are clogged with tobacco ads, small and large.  Sexy men and women in adventurous situations puff away in these ads, sending the message that “you can be sexy like me if you smoke.”

Phillip Morris International and British American Tobacco are gobbling up much of the market share and even venturing into producing kreteks which are clove/tobacco cigarettes often made in cottage industries.  According to a recently published paper by Richard Hurt, Director of the Mayo Nicotine Dependence Treatment Center, “These acquisitions allowed them to assert influences on health policy in Indonesia and to grow their business under current government policy embodied in the 2007-2020 Roadmap of Tobacco Products Industry and Excise Policy which calls for increased cigarette production by 12% over the next 15 years.”

Two things stand out to me as I look at use of tobacco by teens around the world, including the US.

• First, we are not doing enough to prevent teens from starting.  We need to do a better job educating teens about the immediate and long-term dangers of tobacco and work closely with teens who don’t smoke to develop hard-hitting counter advertising that resonates with this population to dissuade them from starting to smoke or chew tobacco.
• Second, we need to better understand how to help teens quit who have started to smoke.  Most adult oriented cessation programs have proved not to be ineffective with teens.  We need good research to inform treatment approaches that meet the needs of this important group of smokers and chewers.

* Photo Caption: “If you’re not allowed it, but you really want it, then you can have it!” - advertisement slogan for Kiss Cigarettes in Russia, 2011

Ken Wassum has been treating tobacco users for over 19 years. He is past President of The Association for the Treatment of Tobacco Use and Dependence and previously served on its Board of Directors. Join him as he blogs about the effects of the tobacco epidemic, the efforts of cessation advocates, and the work left for us to rid the world of nicotine addiction. Read Ken Wassum's blog posts.

Visit www.alerewellbeing.com to learn about Alere Wellbeing’s Quit For Life® Program, the only commercial tobacco cessation program in the U.S. with proof of effectiveness published in multiple peer-reviewed scientific journals over the course of 25 years.

Ariyah DeSouza, Recruitment Marketing Manager

Contrary to popular belief, Cinco de Mayo is not Mexico's Independence Day, which is actually in September. Spanish for “fifth of May,” Cinco de Mayo is observed in the United States as a celebration of the culture and experiences of Americans of Mexican ancestry, much as St. Patrick's Day, Oktoberfest, and the Chinese New Year are recognized to celebrate those of Irish, German, and Chinese ancestry. Similar to these holidays, Cinco de Mayo is observed by many Americans regardless of ethnic origin.

This Cinco de Mayo, millions of Americans will go out with friends for tequila and tacos. Countless bars and restaurants will offer celebratory fare and drinks. For people trying to quit tobacco, social gatherings involving alcohol can trigger the urge to smoke or chew.

Our clients can connect their employees or members with help to combat these urges through timely outreach. Our Cinco de Mayo Promotion – in both English and Spanish – reminds tobacco users that the Quit For Life® Program can help anyone resist tobacco, even when they’re surrounded by environmental temptations. A certified Quit Coach® works with each participant to strategize on how to combat cravings given real life situations.

Your tobacco users are always welcome to join our Quit For Life® Facebook page for further quit support. Our latest Facebook badges were designed for those who want to specially recognize this Cinco de Mayo by quitting tobacco.

And remember to have a ¡feliz Cinco de Mayo!

Ariyah, Recruitment Marketing Manager at Alere Wellbeing, is responsible for the creation of thematic content and promotional campaigns for the program-eligible populations of Alere Wellbeing clients. Follow her blog series, Beyond Employee Benefits Communications, for ideas on how to creatively communicate employee health benefits at your organization.

Visit www.alerewellbeing.com to learn about Alere Wellbeing’s Quit For Life® Program, the only commercial tobacco cessation program in the U.S. with proof of effectiveness published in multiple peer-reviewed scientific journals over the course of 25 years. Quit For Life® is now also available in Spanish. Read the press release.

Ariyah DeSouza, Recruitment Marketing Manager

In May 2011, the Centers for Disease Control and Prevention (CDC) reported on a study showing that cigarette package health warnings increase interest in quitting among smokers. The data revealed that warnings do influence smokers’ desire to quit. This finding is precisely why tobacco companies are fighting federal regulation of tobacco packaging, namely the addition of graphic warnings – which are mandated in dozens of other countries.

The fact that graphic warnings really work inspired our marketing team: why not use warning labels to promote our tobacco cessation program? A compelling campaign featuring warning labels could elicit prospective participants’ attention. And since we know from experience that, for our participants, emotional reasons (rather than scientific reasons) are what stir them to seek support for quitting tobacco, why not focus on the benefits of quitting rather than the damage to health caused by smoking?

So came to be the new Graphic Warnings Campaign for the Quit For Life® Program. Mirroring the look of the Surgeon General’s warnings on tobacco packaging, the campaign’s warnings are immediately recognizable as a positive spin on current text-only labels. Our warnings – like “Quitting Tobacco Will Put More Money in Your Wallet” – remind program-eligible populations of why they want to quit and get support to quit, rather than scare them into trying to quit. Our clients can quickly launch and easily manage the Graphic Warnings Campaign using tips in the Campaign Summary, which we include in each campaign package.

Warning labels work, and a positive spin on them will help motivate your program-eligible populations to quit for good.

Ariyah, Recruitment Marketing Manager at Alere Wellbeing, is responsible for the creation of thematic content and promotional campaigns for the program-eligible populations of Alere Wellbeing clients. Follow her blog series, Beyond Employee Benefits Communications, for ideas on how to creatively communicate employee health benefits at your organization.

Visit www.alerewellbeing.com to learn about Alere Wellbeing’s Quit For Life® Program, the only commercial tobacco cessation program in the U.S. with proof of effectiveness published in multiple peer-reviewed scientific journals over the course of 25 years.

Allegra Wiborg, Lead Trainer, Service Delivery

Remember that old Burger King slogan, “Have it your way”? That’s kind of what the Quit For Life®  Program is like. Except without the burgers. In fact, our company is the opposite of one that endorses a Whopper-eating lifestyle. But let me explain.

Each Quit For Life®  participant gets set up with their own Quit Coach®  to help them build an individualized quit plan. During the intervention, maybe a participant shares she wants to have a lot of vocal social support as she quits, or maybe a participant explains he just wants to let his mom know about his quit—and no one else. Either way is a fine part of a quit plan, as long as the participant is thinking about how they want support.

At Alere Wellbeing, we train Quit Coaches in the theory of participant as educator. That is, Quit Coaches ask probing questions but let the participant tell their story about what they need to quit successfully. How do Quit Coaches know what to ask about? They’re experts in the United States Public Health Clinical Guidelines’ five key behaviors to quitting tobacco:

1. Set a quit date
2. Use cessation medications
3. Develop urge management skills
4. Tobacco-proof the environment
5. Enlist support

While the Quit Coach®  is proficient in the five keys, the participant is the educator about what these keys will to look like in practice. One time a participant told me she wanted to have a funeral for her cigarettes, bury them in the backyard complete with a eulogy—voila! Tobacco-proofing! Another participant told me that when he was jonesing for a cigarette he was going to practice his nunchuck skills—certainly a way to manage your urges.

So, Quit Coaches are armed with the raw material, but the quit plan still needs to be assembled in a way that is palatable for the participant.

With Quit Coaches who assist with—instead of prescribe—a Quit Plan, participants can have it their way. And isn’t success delectable?

As a former Quit Coach®, Allegra remembers the importance of viewing each caller as an individual who brings their past and their personality to the behavior change process. And, she remembers the importance of treating each caller with care. These are elements she tries to share with Quit Coaches in her training classes. Read more of Allegra Wiborg's blog posts.

Learn about the Quit For Life® Program

Read more stories from current and former Quit Coaches

Janice Milliman, Quit Coach, Service Delivery

Tobacco use among adults who live below the poverty line was about 28 percent in 2010, compared to 19 percent for those at or above.  State Medicaid programs who serve those in poverty need to beef up their tobacco-cessation benefits and reduce the barriers enrollees face when trying to access those benefits.

Tobacco cessation benefits may include support calls and medication, such as nicotine replacement (patches or gum) or prescription medications. Tobacco users cost Medicaid programs much more than non-tobacco users, so according to the Tobacco-Free Kids January 2012 factsheet, Comprehensive Statewide Tobacco Prevention Programs Effectively Save Money, Medicaid programs have more to gain by funding and promoting tobacco cessation.  A recently published study on the  return on investment (ROI) of a state medicaid tobacco cessation program found that Massachusetts saved more than $3 for every $1 spent, and that the reductions in cardiovascular hospitalizations alone saved about $14.7 million for the state Medicaid program.

Medicaid programs have a specific process that each enrollee must adhere to in order to receive the benefits to which they are entitled. Such processes are in place likely to control cost, ensure proper treatment, and possibly to prevent fraud. Unfortunately, some state Medicaid programs have too many hoops to jump through. With so many possible breakdowns in the system, enrollees face delays in quitting, discouragement, and some simply give up. Additionally, many Medicaid enrollees are less-well educated and may have physical or mental limitations that make it more difficult to jump through hoops.

The million-dollar question is, then, if tobacco prevention and cessation programs reduce smoking, save lives, and save money by reducing tobacco-related health care costs, why don’t more state Medicaid programs allocate funding and create a reasonable process for accessing benefits?

Most tobacco users say quitting is one of the hardest things they've ever done. Janice, a Quit Coach®, feels that helping people succeed and overcome feelings of shame are some of the highlights working at Alere Wellbeing. Read more of Janice Milliman's blog posts.

Learn more about the Quit For Life® Program

Read more stories from current and former Quit Coaches

Ken Wassum, Associate Director, Clinical Development & Support

For the past two or three decades, some brilliant people in the US and abroad have made a priority of reducing disease and death – and those committed to reducing the toll of tobacco continue to work tirelessly and with tremendous optimism. Having just returned from the 15th World Conference on Tobacco or Health in Singapore, I am encouraged by the progress made in some areas of tobacco control, yet very discouraged by the lack of progress in others.

Over the course of the next several weeks I will be posting a series of blog posts that address many of these issues and more in greater detail.

To get started, let’s look at some of the accomplishments we’ve made over the past couple decades:

• 174 countries have signed and ratified the World Health Organization’s Framework Convention on Tobacco Control that addresses the tobacco epidemic from both policy and treatment perspectives.
• More countries than ever provide access to toll-free tobacco Quitlines, including North America where all 50 states, 3 US territories, and 12 Canadian provinces have such services. Quitlines exist throughout Europe and in many parts of Asia and Oceania.
• Many countries with National Health Services, such as the UK, have expanded community-based clinical treatment for tobacco use.
• Graphic warnings on cigarette packs have been adopted by many countries around the world. In some countries “plain packaging” is on the horizon.
• Many countries have raised taxes on tobacco products, especially cigarettes, resulting in lower tobacco use prevalence.
• The US FDA has been given unprecedented authority to regulate tobacco products.
• Tobacco use prevalence in the US has declined from about 27% in 1991 to about 19% in 2010.

Yet, should you think these accomplishments mean we are “winning” the battle, here are some sobering, even chilling, facts:

• In 2011, tobacco use killed almost 6 million people worldwide.
• Global tobacco-related deaths have nearly tripled in the past decade.  The number of annual deaths in the US from tobacco use (443,000) has remained unchanged for the past couple decades.
• Each day, nearly 4,000 kids in the US try their first cigarette and an additional 1,000 kids under 18 years of age become new regular, daily smokers. That’s nearly 400,000 new underage daily smokers in this country each year.
• If trends continue, 1 billion people around the world will die from tobacco use and exposure during the 21st century. To put that mind-boggling number in perspective, that’s 1 person every 6 seconds.
• Tobacco tax revenues in the US have reached unprecedented levels at the state level and the national level, yet tobacco control remains shamefully under-funded and under-resourced. Margaret Chan, Director General of the World Health Organization, sums it up succinctly when she states, “Measures to tackle the epidemic remain seriously under-funded.”
• Cessation services to help tobacco users quit remains the “orphan” of tobacco control and fails to be resourced to its full potential. It has become an issue of social justice.
• The tobacco industry in their multi-national capacity have increased their efforts to both confound and delay tobacco control in the US and have increased efforts to sell their deadly products abroad, targeting women and children in developing countries. They continue to challenge the FDA in implementation of evidence-based initiatives by the Center for Tobacco Products.
• According to the March 2012 Surgeon General’s Report, one in five high school students in the US smokes, and over half of these youths also use a smokeless tobacco product. Nearly 90% of youths start smoking before the age of 18.

We are clearly at a crossroads. Smoke-free laws have taken effect across the US, and the public has the mistaken perception that the battle against tobacco use has been won. Yet those dying of tobacco-related diseases continue to die behind closed doors, away from public view. Dying from smoking is rarely quick and never painless. Many governments around the world, including the US, continue to underfund proven strategies to reduce disease and death caused by tobacco products and under-prioritize the enormity of the tobacco epidemic, especially among our children and our most vulnerable populations.

There is a lot to discuss here, so please stay tuned.

Ken Wassum has been treating tobacco users for over 19 years. He is past President of The Association for the Treatment of Tobacco Use and Dependence and previously served on its Board of Directors. Join him as he blogs about the effects of the tobacco epidemic, the efforts of cessation advocates, and the work left for us to rid the world of nicotine addiction. Read Ken Wassum's blog posts.

Visit www.alerewellbeing.com to learn about Alere Wellbeing’s Quit For Life® Program, the only commercial tobacco cessation program in the U.S. with proof of effectiveness published in multiple peer-reviewed scientific journals over the course of 25 years.

Ken Wassum, Associate Director, Clinical Development & Support

The CDC, and specifically its Office of Smoking and Health, should be heartily congratulated on the graphic ad promotional campaign scheduled to launch today, March 19. We’ve greatly anticipated these ads, especially in light of a recent (misguided) court ruling that the government could not require the tobacco industry to put graphic warnings on cigarette packs to replace the tired old ineffective warnings that have been on cigarette packs since the 1970’s.

After seeing the ads some in the press have wondered if the ads are too graphic and too shocking. I would suggest that they are not too graphic and the reason is that the public has become immune to the current warnings on cigarette packaging. Here are the facts after over 40 years of text-based warnings on cigarette packs:

• Over 1,200 people die every day (443,000 per year) in the US as a direct result of smoking.
• One of every two smokers will die prematurely.
• The average smoker will die 14 years early.
• Cigarettes are the only product sold in the US that when used as recommended (needless to say advertised, promoted and discounted) by the manufacturer results in disease and death.

There is hope that the new ads will help shed light on the harrowing reality of tobacco-related diseases. Cancer of the throat is an abstract concept for those who do not have it. The "Tip From a Former Smoker" ad featuring Terrie makes it real – certainly not as real as it is for her, but certainly a lot more real than a text on a cigarette pack that says, “Smoking can cause cancer of the throat.”

In response to these ads, the Atria Group, the parent company of Philip Morris USA and U.S. Smokeless Tobacco, states, “We support a three-part approach to reducing the harm caused by cigarette smoking: preventing underage tobacco use, promoting quitting and a focus on the development of and appropriate communications about potentially lower risk tobacco products,” the company said in a statement. “We believe we can play an important role in this effort and will continue to work with the FDA and others in public health to help reduce the overall harm of tobacco products.”

Yet the tobacco industry does everything it can to sell their deadly products to youth in the US and especially in foreign countries (like Indonesia) and promote their deadly products to adults in the US and overseas (like Camel Orbs).

So hats off to the CDC for taking action. Hopefully the courts will come to their senses and reverse the decision by Judge Richard Leon banning implementation of graphic warnings on cigarette packs. Let’s hope these new ads cause smokers to pick up the phone and call their state tobacco quitline for help.

Ken Wassum has been treating tobacco users for over 17 years. He is past President of The Association for the Treatment of Tobacco Use and Dependence and previously served on its Board of Directors. Join him as he blogs about the effects of the tobacco epidemic, the efforts of cessation advocates, and the work left for us to rid the world of nicotine addiction. Read Ken Wassum's blog posts.

Visit www.alerewellbeing.com to learn about Alere Wellbeing’s Quit For Life® Program, the only commercial tobacco cessation program in the U.S. with proof of effectiveness published in multiple peer-reviewed scientific journals over the course of 25 years.