1. BACKGROUND
   1. General:

      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 comprehensive program.54

      This component will be used to address the following goal and objectives:

      Goal 3:	To increase the number of youth and adult tobacco users who initiate treatment
      	Increase the number of organizations offering nicotine treatment programs
      	Increase awareness of the availability of nicotine treatment programs for:
      	(a) general population of smokers
      	(b) high risk sub- population groups
      	Increase the number of individuals accessing nicotine treatment programs

   2. 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 this time.

      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.

   3. 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.

2. 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.

   1. Target Populations

      Nicotine treatment programs will be expected to target both adolescent and adult smokers.

   2. Basic Principles:

      As the program begins to develop, it is important to incorporate the following basic principles:

      1. 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 other addictions.

      2. 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.

      3. DHSS will identify organizations where physicians and others can refer patients if they need additional assistance to quit.

      4. 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.

      5. Nicotine addiction treatment should be integrated into other non-medical settings (e.g.: health clubs, vocational schools, campuses, senior centers).

      6. Programs must be culturally appropriate for targeted audiences.

   3. Opportunities for Public/Private Partnerships

      To increase the availability and awareness of nicotine treatment programs, the following partnerships may be appropriate:

      1. Pharmaceutical companies promoting NRT;
         
      2. Medical associations (e.g. Academy of Medicine, Academy of Pediatrics);
         
      3. Community-based organizations; and,
         
      4. Non-medical settings.

Return to Cover Page |  Next Section