Statement of Jessie Gruman, PhD

President and Executive Director of the Center for the Advancement of Health
on behalf of the
Center for the Advancement of Health and the American Psychological Association
Before the Interagency Committee on Smoking and Health
Subcommittee on Tobacco Cessation

I am here today as the President of the Center for the Advancement of Health (CFAH) representing the views of the Center and as a social psychologist representing the views of the American Psychological Association.

The Center is an independent, nonpartisan nonprofit organization funded by the John D. and Catherine T. MacArthur Foundation. The Center’s mission is to promote the translation of health research into effective policy and practice. The Center has long advocated for the use of evidence to drive tobacco control strategies. Among other things, we convened the Ad Hoc Working Group on Treatment of Tobacco Dependence, led the intersectoral effort to develop HEDIS performance indicators for tobacco use, we currently staff the Youth Tobacco Cessation Collaborative and I co-chair NOTURF, a consortium of 20 tobacco use research funders.

Many of the scientists and clinicians we work with on these initiatives are psychologists and it is my pleasure to also represent the contributions of that profession broadly here today on behalf of the American Psychological Association.  The APA represents 155,000 members and affiliates, and works to advance psychology as a science, a profession, and as a means of promoting health and human welfare. APA scientists have been involved in tobacco control research studying everything from the behavioral pharmacology of nicotine dependence to evaluating the efficacy of buyer/seller penalties on underage tobacco sales. Clinical psychologists are daily helping people to quit using tobacco all over the country and have contributed their expertise to local tobacco control efforts as well as to national efforts such as the panel that developed the current USPHS Tobacco Cessation Guidelines.

Thank you for providing this opportunity for the Center and APA to contribute to the deliberations of your subcommittee.

Tobacco use cessation has a funny history — it took us years to figure out that a national strategy built around 10-session group smoking cessation interventions was both impractical and expensive — and that there were many gains to be had from a population-based approach. Now that population-based strategies dominate tobacco use cessation, we have largely abandoned efforts to define and implement a standard of care for those tobacco users for whom brief approaches don’t work.

These people are often heavily addicted smokers. Many have complicated psychiatric and physical co-morbidities. Inasmuch as a “system” for tobacco use cessation exists, it currently is unable to identify and intervene with users who need intensive treatment in order to quit.

The Center for the Advancement of Health and the APA ask that the Subcommittee consider the following concrete recommendations for how to fill this gap as part of its broader cessation efforts.

  • Support the development of evidence-based profiles of tobacco users who would benefit from intensive approaches.

  • Contract for research to answer key practical questions about the content and delivery of intensive interventions: what elements are necessary, what intensity is optimal, etc.

  • Based upon findings from this research, support a systematic evidence review of intensive approaches to tobacco use cessation.

  • Encourage professional societies like the APA to develop clinical practice guidelines and to include them in mandated continuing education programs.

  • Support the Practice-Based Research Networks of the Agency for Healthcare Research and Quality to conduct research to identify how intensive tobacco use cessation can be integrated into (or annexed to) health care practice.

  • Call for SBIR applications for the development of technological approaches to delivering intensive services consistent with the evidence reviews.

  • Encourage reimbursement for nicotine replacement therapies under Medicare and make a strong case for the same under Medicaid.

  • Encourage reimbursement for the services of health professionals when these have been shown to be a necessary aspect of successful smoking cessation independent of the existence of a medical or psychiatric diagnosis.

  • Encourage the development of support for intensive cessation service, including nicotine replacement therapy for those who are uninsured or underinsured.

These actions are not expensive or complicated. But they have the potential to ensure that all tobacco users have access to the services they need to save their lives. We urge you to consider them.

Thank you.

Jessie Gruman, PhD
President and Executive Director
Center for the Advancement of Health
2000 Florida Avenue, NW, Suite 210
Washington, DC 20009