HHS can increase collective impact by introducing goal specific recommendations for smoking cessation

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BCHC responded to the Department of Health and Human Services (HHS) proposed 2023 Framework to Support and Accelerate Smoking Cessation. BCHC commends HHS for leveraging its leadership and expertise to help ensure additional investments in tobacco prevention and cessation which will reduce tobacco-related health disparities and reduce the cost of treating tobacco-related disease.  

HHS should consider the following goal specific recommendations to increase our collective impact. 

• Goal 1: Eliminate Smoking- and Cessation-Related Disparities
  • Improve state and local health department capacity to enhance the delivery of tobacco cessation services through a fully funded Office on Smoking and Health at the CDC.  
  • Reduce barriers to cessation treatments, especially language and cost barriers that exacerbate underlying causes of smoking and cessation-related disparities. 
  • Promote and provide resources for peer and social support groups, especially in populations where other behavioral interventions have been underutilized, which also tend to be populations affected by tobacco-related disparities. 

• Goal 2: Increase Awareness and Knowledge Related to Smoking and Cessation
  • Engage community and tribal partners to create and refine culturally responsive messaging and outreach, increasing relevance to populations disparately affected by smoking. 

• Goal 3: Strengthen and Sustain Cessation Services and Supports
  • Working directly with local and tribal public health is particularly essential because successful tobacco prevention and cessation programs require relationship building in communities and trusted messengers to ensure programs and interventions are relevant to those who are intended to benefit. The hyperlocal nature of prevention and cessation efforts requires distribution of resources based on need and potential reach. 

• Goal 4: Increase Access to and Coverage of Comprehensive High-Quality Cessation Treatment
  • Improve coverage of tobacco cessation treatment in Medicare, Medicaid and private insurance through the following strategies:
    • Provide additional guidance to private plans on the need to cover all FDA-approved medications and all three forms of counseling without barriers to access.  
    • Provide additional guidance to state Medicaid programs on the need to cover all FDA-approved medications and all three forms of counseling without barriers to access for both expansion and standard enrollees.  
    • Work with Medicare Managed Care plans to improve tobacco cessation benefits.  

• Goal 5: Expand Surveillance of Smoking and Cessation Behaviors and Strengthen Performance Measurement and Evaluation
  • Big city health departments exist on a spectrum of capacity and modernization, but they all agree that in order to use data for action that includes health equity, data modernization must prioritize data standards (especially race and ethnicity data collection), interoperability (especially between states and locals, including local access to local data processed through state systems) and data linkages. Data linkages are especially important in the context of smoking cessation given that the bulk of population-level cessation program data currently comes from health care systems, payers, and state quit lines. 
  • Local health departments need direct support for program evaluation as a commitment to continuous quality improvement and measurement of impact, especially impact on populations disparately affected by smoking. Local program evaluation will also increase awareness and understanding of new cessation interventions, one of the broad strategies under Goal 6. 

• Goal 6: Promote Ongoing and Innovative Research To Support and Accelerate Smoking Cessation
  • To identify gaps in our current understanding about what works to effectively address smoking cessation, HHS should make an explicit commitment through its cessation framework to include more Black, Indigenous, Hispanic, and other underrepresented groups in clinical studies. 
  • Consider community-based participatory research (CBPR) to better understand how to maximize the reach, engagement, and effectiveness of current smoking cessation interventions, particularly among populations disparately impacted by smoking and tobacco-related illness. Sharing of data and resources generated by federally funded research is an essential principle of CBPR in which community-based researchers lead the translation of data from research for both dissemination and intervention. 
  • Finally, use existing authorities in CEDR to encourage the development of additional cessation medications for both adults and children. 

Targeted actions HHS can take to advance these goals and strategies include:

• Direct funding to local health departments and
• Stay in close and direct contact with BCHC and the 35 officials who are our members.

HHS should also ensure adequate resources to understand community-level impact of smoking cessation interventions.

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