State of Hawaii: "The Aloha State"

Total population: 1.2 million
Adult smoking prevalence: 21.4%
Youth smoking prevalence: 24.5%
Pregnant smoking prevalence: 7.1%
Total funding for tobacco control in FY 2005: $8.9 M
Proportion for tobacco cessation: 15%

Cessation Services Profile

Quitline services: And RFP was released January 19, 2005 and expected operational date is July 15, 2005.

Medicaid coverage & services: Limited to pharmacotherapy (prescription only, OTC NRT is not covered). Zyban, NRTs upon obtaining authorization (Medicaid patients covered by HMSA insurance --- receive some telephonic counseling, group counseling, and pharmacotherapy coverage).

Health plan coverage & services: HMSA (Hawai‘i Medical Services Association, the Blue Cross-Blue Shield affiliate), which insures approximately 66% of Hawaii’s residents (including HMSA provided Medicaid services) recently implemented their “Ready Set Quit” program through their behavioral health component that offers telephone-counseling support to HMSA members (co-payment varies among health plan type). Pharmacotherapy (prescription only, OTC NRT is not covered) is offered to all members with drug coverage - about 80% of members.

Kaiser, which insures 20+% of Hawaii’s residents, offers cessation counseling and pharmacotherapy (prescription only, OTC NRT is not covered) to all members with drug coverage.

Key partners in tobacco cessation:

  • American Lung Association
  • Hawaii Medical Service Association (Blue Cross/Blue Shield)
  • Several Local Coalitions (i.e. Kauai, Big Island)
  • Several community heath centers
  • Hawaii Prevention and Control Trust Fund (administered by the Hawai‘i Community Foundation)
  • State Department of Health
  • Coalition for a Tobacco Free Hawai‘i
  • HMSA
  • Kaiser
  • Castle Medical Center
  • Queens Medical Center

Primary leadership: The cessation advisory group, which is coordinated by the Coalition for a Tobacco Free Hawaii, provides leadership in coordinating cessation services and issues in the state.

Status of cessation program: Currently, a cessation advisory board has been coordinating and meeting monthly to discuss and coordinate a statewide comprehensive cessation system. This comprehensive system will be integrated within the five-year statewide tobacco control strategic plan that is currently being developed and coordinated.

We are in the process of conducting a survey to identify existing cessation services in community settings, health care setting, private vendors, schools, etc beginning February. The quitline RFP has been issues and will be operational in July. Development and discussions are ongoing on outreach to health care providers and health care systems and on programs to reach multicultural and underserved populations.

Key successes:

  • Commitment by Trust Fund Advisory Board to build a comprehensive cessation program statewide, and allocate significant resources for this
     
  • Training program for brief interventionists statewide, with an increasing number (approximately 300) people trained statewide. Under discussion are developing standards and a training program for tobacco cessation specialists.
     
  • A grant-making program that has funded 22 community-based agencies over the past 3 years to improve and increase their cessation programs (approximately $1.7 million committed).
     
  • The beginnings of a strong partnership of various entities in building a statewide cessation program through the Cessation Advisory Group
     
  • Components for a comprehensive cessation program exists
     
  • Highly cooperative insurance providers
     
  • Tobacco Treat Specialist (approximately 25) trained
     
  • Release of Quitline RFP
     
  • Assessment of existing cessation programs/services as well as identification of gaps of services

Key challenges:

  • Maintaining the level of allocation to the Tobacco Prevention and Control Trust Fund remains a continuous challenge each legislative session, as the state seeks funding for other needs.
     
  • Effectively reaching not only people who are ready to quit, but also to be able to reach those that need support to move closer to being ready to quit.
     
  • Planning is underway to build a comprehensive tobacco control program statewide, but much remains to be done, including developing a statewide infrastructure to coordinate and manage Hawaii’s comprehensive tobacco control program.
     
  • Hawaii’s Medicaid program currently does not cover tobacco cessation counseling.
     
  • Establishing a good evaluation program to measure the effectiveness of the statewide cessation efforts.
     
  • Leadership and role delineation with department of health and others. The usual personality conflicts and power struggles.
     
  • Low demand for services and no overall coordination within providers
     
  • Partnership among lead agencies, delineation of roles
     
  • Building capacity in cessation treatment specialists area
     
  • Integration of the upcoming quitline with cessation services statewide


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1 Sustaining State Programs for Tobacco Control: Data Highlights 2004, CDC
2 Sustaining State Programs for Tobacco Control: Data Highlights 2004, CDC (grades 9-12
3 CDC. Smoking During Pregnancy --- United States, 1990--2002. MMWR 2004; 53(39);911-915.
4 Percentage of mothers who smoked during pregnancy by area: 2002
5 Campaign for Tobacco Free Kids. FY2005 Rankings of State Funding for Tobacco Prevention: www.tobaccofreekids.org 6 MSA, General fund (1%) and CDC

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