May 13, 2008 The New York Times No one really knows how the African-American preference for menthol cigarettes developed in the first place. Some scientists speculate that cultural and taste preferences provide a partial explanation. The Rev. Jesse Brown, an antismoking advocate in Philadelphia, calls it a “chicken and egg” conundrum. But tobacco industry marketing has played a role. The migration of African-Americans to urban manufacturing centers after World War II, coupled with the emergence of black-oriented newspapers and magazines, created various opportunities for niche marketing. In the case of cigarettes, with research showing a slight black preference for Kools, a menthol brand, the industry saw an opening to appeal to black smokers. Or at least that is the explanation central to a paper on the history of menthol marketing by Phillip S. Gardiner, the research administrator of a tobacco disease program at the University of California, Oakland. The paper notes that Elston Howard, who became the first black player for the New York Yankees in 1955, was hired as a Kool spokesman. By 1978 Lorillard, Newport’s maker, had borrowed the singer James Brown’s hit single, “Papa’s Got a Brand New Bag” for its marketing message, “Newport is a whole new bag of menthol smoking.” Dr. Gardiner’s paper, published in 2004 in the journal Nicotine and Tobacco Research, also notes that by the 1980s, Brown & Williamson, the maker of Kool, had started its Kool Jazz Festival to appeal to the same market. More recently, hip-hop artists have helped promote Kool, now the third-biggest menthol brand, which was acquired in 2004 by R. J. Reynolds. Dr. Brian A. Primack, assistant professor at the University of Pittsburgh School of Medicine and the author of a study published last year on the concentration of tobacco signs and billboards in African-American neighborhoods, said observational evidence suggested that about three-fourths of outdoor cigarette advertising in African-American neighborhoods was for menthol brands. Magazine advertising for cigarettes has declined since the 1998 tobacco industry settlement with state attorneys general. But the portion devoted to menthol brands — only 12 percent in 1998 — had grown to 76 percent by 2006, according to an recent analysis by the Tobacco Control Research Program at Harvard. Lorillard’s Newport, the country’s second-biggest selling cigarette and the leading menthol brand, is the best seller among African-Americans. “It’s very much marketed with youth orientation, and the primary distribution is in delis and bodegas,” said K. Michael Cummings, the chairman of the department of health behavior at the Roswell Park Cancer Institute in Buffalo. The tobacco companies do not agree that black smokers are a special target for menthol marketing. A Lorillard spokesman, Michael W. Robinson, said that Lorillard, a subsidiary of Loews Corporation, marketed its product across a wide array of ethnicities to adult smokers. “Lorillard wants the widest customer base possible among adults,” Mr. Robinson said. He said that only 15 percent of the company’s advertising budget is directed at the African-American market segment. David P. Howard, a spokesman for R. J. Reynolds, a unit of Reynolds American, which markets menthol brands including Kool and Salem, said his company also advertised to a wide range of audiences, because with so many more white smokers than black, only 18 percent of R. J. Reynolds’ menthol sales are to African-Americans. But he acknowledged that the company does try to appeal to black smokers: “Would we like African-Americans to choose R. J. Reynolds brands? Yes, we would. Do we have marketing and communications that that audience can identify with? Yes, we do.”

The Gov's Office of Health Care Reform (GOHCR), through the Chronic Care Initiative (CCI), aims to implement the Chronic Care Model in PA and is the umbrella organization for this collaborative, statewide effort that brings together many stakeholders (including health plans). Learning collaboratives are being formed in PA's six regions, starting in SE May 15, SC in October and SW or NE in November. Learning collaboratives are formal groups of about 30 primary care practices (they sign 3-year contracts), which will be supported by quality improvement coaches via IPIP, report on measure sets (diabetes and asthma initially) provided by IPIP using a patient registry provided by IPIP. The learning collaboratives kick off at sessions, organized by the GOHCR, that provide education on the models as well as compensation for time spent out of the practice by participating physicians and staff. The learning collaboratives have follow-up sessions to share lessons learned and continue learning about the models. All of these services are free to practices. The CCI will be initiated in the remaining regions in 2009 while also going back to the SE to develop another learning collaborative and offer other clinical topics (perhaps something in prevention). It's been said that 500 practices is the "tipping point" - that point where change becomes permanent - so we will continue to recruit practices and implement the Chronic Care Model. Link: http://www.pafp.com/

The Pennsylvania Department of Health is pleased to announce the Pennsylvania Cancer Education Network (Network) as a new cancer control initiative in the commonwealth that aims to help reduce the number of cancer cases and deaths in Pennsylvania

Feb 8, 2008

The Centers for Disease Control and Prevention (CDC) this week called on states to dramatically increase their Medicaid tobacco dependency treatment coverage. The CDC report cited the Healthy People 2010 goal of instituting total health insurance coverage for evidence-based tobacco cessation treatments in all 51 state Medicaid programs, AHA News Now reports. In this week's Morbidity and Mortality Weekly Report, the CDC outlines results from a 2006 nationwide survey, which indicates that 39 state Medicaid programs offer some form of tobacco-dependence treatment coverage for beneficiaries, one-third of whom smoke. While all programs cover some form of pharmacotherapy and 17 states cover some form of cessation counseling services, many Medicaid programs have limitations on coverage for treatment. Barriers include co-payments, requirements for prior authorization, caps on treatment duration, requirements that patients try one form of therapy before beginning another and provisions for covering a single treatment type at a time. Reinforcing results of a May 2007 Institute of Medicine report that recommended all health plans offer lifetime tobacco cessation benefits, the CDC advocates full Medicaid coverage for recommended tobacco-dependence treatments to reduce tobacco use (AHA News Now, 2/7/08; CDC report, 2/8/08).

North Carolina Group Receives Grant to Improve Diabetes Care for Minorities

Jan 29, 2008

The North Carolina Health and Wellness Trust Fund, one of three entities created by the General Assembly to invest the state's portion of the Tobacco Master Settlement Agreement, has awarded $326,699 to Robeson Health Care Corp. for efforts to eliminate health disparities among diabetic minorities living in Robeson County, the Fayetteville Observer reports. Using the award, Robeson Health Care will partner with the Diabetes Community Center at Southeastern Regional Medical Center to improve the coordination of preventive and chronic care services for Native American, African-American and Hispanic diabetes patients. In addition, the organizations will work to improve education and nutrition counseling for those patient populations (Fayetteville Observer, 1/28/08; North Carolina Health and Wellness Trust Fund Web site).  

http://www.rwjf.org/programareas/features/digest.jsp?c=EMC-ND141&pid=1141&id=7138

 

Diabetes-Related Health Costs Soared to $174 Billion in 2007

Jan 28, 2008

A report released last week by the American Diabetes Association (ADA) finds that diabetes cost the United States $174 billion in 2007 in direct medical care and lost productivity, marking a 32 percent increase over 2002 costs, USA Today reports. According to the report, approximately 1 million people are diagnosed with diabetes each year, with much of the disease's associated expense stemming from the treatment of patients with unmanaged diabetes. Regular physician visits, medications and other forms of routine care, meanwhile, were found to have a comparatively smaller effect on overall diabetes costs. In addition, the researchers found that approximately half of all diabetes costs related to inpatient care. The disease also was associated with a 50 percent increase in the length of hospital stays for other conditions. To put diabetes' $174 billion toll in perspective, USA Today notes that the disease costs almost as much as cancer, which cost the nation just over $206 billion in 2006 but kills twice as many people, according to the American Cancer Society. In other terms, diabetes spending in the United States is nearly on par with the amount spent on the military efforts in Iraq and Afghanistan and the global war on terrorism combined (Szabo, USA Today, 1/24/08; ADA report, 1/23/08).

 http://www.rwjf.org/programareas/features/digest.jsp?c=EMC-ND141&pid=1141&id=7133

 

Evidence Supports Nurse-Delivered Smoking Interventions, Researchers Suggest

Jan 24, 2008

A meta-analysis published this month in the Cochrane Database of Systematic Reviews suggests that nurse-delivered tobacco cessation counseling is effective in helping patients quit smoking, United Press International reports. To evaluate the efficacy of various smoking interventions, researchers from Wayne State University College of Nursing assessed data from 42 randomized clinical trials involving a total of more than 15,000 patients. In 31 studies comparing nurse-led interventions with a control or conventional care, nurse involvement was associated with a significant increase in the likelihood that participants would quit smoking, particularly when the counseling was delivered in a hospital setting. Only 3 percent of patients given no intervention were able to quit smoking, compared with between 15 percent and 20 percent of those guided by nurses. While the lead study author acknowledges that nurses already have heavy workloads, she suggests that an investment in smoking cessation interventions could head off future health complications and "reduce [nurses'] workload" in the long run (United Press International, 1/23/08; Rice and Stead, Cochrane Database of Systematic Reviews, 1/23/08 [subscription required]).

http://www.rwjf.org/programareas/features/digest.jsp?c=EMC-ND141&pid=1141&id=7114