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A single session on smoking cessation each year can yield significant benefits
Short annual tobacco counseling would lower the average frequency of smoking cigarettes and could prevent more than 110,000 deaths annually, according to study findings published in Annals of Family Medicine.
The researchers also found that such counseling could lead to almost 1.8 million additional quality of life years..
“Only one-third of the potential health and economic benefits of counseling are being realized at current counseling rates,” Michael V. Maciosek, PhD, of the HealthPartners Institute in Minneapolis, and colleagues wrote, while also noting tobacco counseling competes with many other health-related items that may come up during a patient’s visit. “We did not find that primary prevention (youth counseling) was more valuable than secondary prevention (adult counseling). Both are clearly of high value.”
Maciosek and colleagues simulated the long-term value of providing short, annual tobacco interventions recommended by the U.S. Preventive Services Task Force to youth and adults over the lifetimes of a U.S. birth cohort of 4 million patients using the HealthPartners Institute ModelHealth: Tobacco microsimulation model. Costs were adjusted to 2012 dollars, and quality-adjusted life years (QALYs) were lowered to present value at 3% per year to determine cost-effectiveness.
The researchers reported that if counseling against initiation were provided to all youth, prevalence would peak at 15.5%. Youth counseling would increase QALYs by 756,601 over the lifetime of the cohort and avoid 42,686 smoking-attributable fatalities.
If cessation counseling were provided to all adults, prevalence would peak at 16.8%. Adult counseling would increase QALYs by 1,044,392 over the lifetime of the cohort and avoid 69,901 smoking-attributable fatalities. Youth counseling would result in net savings of $225 per youth and $580 per adult over their respective lifetimes. Maciosek and colleagues also reported that if annual tobacco counseling was provided to the cohort during both youth and adult years, then adult smoking frequency would be 5.5% lower compared with no counseling, and there would be 105,917 fewer smoking-attributable fatalities over the cohort’s lifetimes.
“Despite limited precision, the results indicate that tobacco cessation counseling should be a high-priority use of clinic resources. Systems improvements may improve cessation counseling through standardized assessment forms, electronic health record prompts, and provider feedback.” Maciosek and colleagues wrote. – by Janel Miller
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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This study shows the value of pediatric health care provider counseling to protect our youth from tobacco and nicotine. A very small investment in time and energy over time leads to the savings of a substantial amount of health care dollars as well as Quality Adjusted Life Years. Although a simulation study, their models and assumptions are based on well-established research. Unfortunately, many pediatric health care providers do not put the energy into counseling that they need to.
The role of the pediatric health care providers in counseling children about tobacco is important. Effective and evidence-based public policies are also important. Simple actions such as raising the age for sale to 21 years, enforcing those restrictions, and increasing tobacco taxes can have a major impact. Other evidence-based actions, including restricting advertising and promotion in media accessible to youth, prohibiting characterizing flavors in tobacco products (which increases appeal to youth), restricting tobacco product use in public, and counter-advertising campaigns that tell youth the truth about tobacco and nicotine, can go even further to protect our youth from tobacco and nicotine. Tobacco control activities need to be adequately funded.
In fighting the tobacco epidemic, we need a multi-pronged approach. There are many actions evidence based actions that have been clearly shown to be effective — both from health care providers and public policy decision makers. Now our challenge is to have the will to implement them.