Aetna’s dentists get iPads to help patients stop smoking

Aetna is set to begin a trial program that equips New York City-area dentists with iPads to help them better educate their patients about tobacco use in an effort to curb smoking. The trial program includes a clinical decision support system (CDSS) that is built on a medical knowledge base, patient data, and decision support technology that provides dentists with personally targeted advice for each patient.

The trial is still in its earliest stages: Aetna is working with Columbia University to design and implement the program.

Dr. David Albert DDS, Director of the Division of Community Health at the Columbia University College of Dental Medicine in New York City, is the principal investigator for the study, which aims to determine how impactful such a CDSS system is on the patient population.

The study is called, “The Dental Tobacco Cessation iPad” and it still has undergo testing and modifications before it rolls out formally at five NYC dental offices.

“The program is designed as an innovative interface between patients and dentists and we anticipate that devices like the iPad can be used to break down barriers between clinicians’ and their patients,” said Dr. Albert. “We will evaluate if we are able to encourage and assist dentists to provide tobacco cessation advice and assistance for their patients who use tobacco products. Tobacco use poorly affects the mouth and teeth and the patient’s overall health. Helping patients to quit tobacco use is a goal that the US Public Health Service encourages all dentists to adopt.”

For more on Aetna’s iPad trial, read the press release below:

PRESS RELEASE: HARTFORD, Conn. — With cigarette smoking causing about 1 of every 5 deaths in the United States each year, Aetna (NYSE: AET) is piloting a new program to support dentists in adopting the United States Public Health Service (USPHS) five A’s tobacco cessation guidelines – Ask, Advise, Assess, Assist and Arrange.

“Our work is designed to support not only dentists and their clinical staff, but also the well-being of their patients and our members”

“Our work is designed to support not only dentists and their clinical staff, but also the well-being of their patients and our members,” said Dr. Mary Lee Conicella, Aetna’s chief dental officer. “Numerous investigations, along with Aetna’s own work in dental offices, provide evidence that many dentists engage in Asking and Advising about tobacco use. However, the remaining A’s do not receive adequate attention in the clinical setting.”

Through the new program, Aetna will promote tobacco counseling by dentists and will study the impact that a smoking cessation clinical decision support system (CDSS) has on a patient’s tobacco use. A CDSS is a system designed to integrate a medical knowledge base, patient data and decision support technology to generate case specific advice. Aetna will be working with Columbia University to design and implement the program; Aetna will carry out the pilot in network dental offices in the New York City area.

“The study will help us gather input from general practice dentists to develop, refine and pilot test an innovative clinical decision support system – the Dental Tobacco Cessation I-Pad,” reported David A. Albert, DDS, MPH the Principal Investigator for the study. Dr. Albert is the Director of the Division of Community Health at the Columbia University College of Dental Medicine in New York City.

The 2-phase pilot includes multiple evaluation methods to assess dentist practice preferences and dental office workflow integration. The Dental Tobacco Cessation I-Pad will undergo rigorous testing with relevant program modifications before a formal study is conducted in five general NY dental offices. The study will help evaluate the adoption and maintenance of the CDSS in clinical practice by dentists and their office staff, as well as patients. A manual of operations will be developed and updated throughout the study.

“The program is designed as an innovative interface between patients and dentists and we anticipate that devices like the iPad can be used to break down barriers between clinicians’ and their patients,” said Dr. Albert. “We will evaluate if we are able to encourage and assist dentists to provide tobacco cessation advice and assistance for their patients who use tobacco products. Tobacco use poorly affects the mouth and teeth and the patient’s overall health. Helping patients to quit tobacco use is a goal that the US Public Health Service encourages all dentists to adopt.”

Rambam bans cigarette sales at hospital

Rambam Medical Center in Haifa has become “the first government hospital” in the country to prohibit voluntarily the sale of tobacco products in shops, kiosks and vending machines on its whole campus.

It has thus altruistically decided to forgo annual income of hundreds of thousands of shekels from commissions and rentals, it said.
Originally, Rambam said on Monday it was the “first hospital in the country” to bar the sale of tobacco on its campus, but when The Jerusalem Post found at least two other medical centers – Jerusalem’s Shaare Zedek and Hadassah University Medical Center on Mount Scopus – that have not allowed the sale of tobacco for years, even decades, Rambam changed its statement to “the first state hospital.”

The management decision, which took effect this month, resulted from a matter of principle – of promoting good health, said Rambam Director-General Rafael Beyar, himself an interventional cardiologist. Beyar, who initiated the move, said a medical institution that daily witnesses the damage caused by cigarettes to health had to “make a clear statement” against smoking.

When the Post asked the Health Ministry whether it would now prohibit the sale of tobacco at all other government hospitals – it responded: “The ministry congratulates Rambam Medical Center and its blessed activities in fighting smoking and hopes all hospitals in the country follow in its footsteps.”

After prodding, the ministry expanded its response and said its director-general, Prof. Ronnie Gamzu, will “consider, within his authority, directing all the general hospitals to prevent the sale of cigarettes” on their premises.

Beyar said that in recent weeks his hospital has made great efforts to set up “smoking corners” in specific areas in the hospitals and educational and informational signs, especially forbidding smoking outside the doors leading to the hospital wards, where smoking is especially annoying and harmful.

Rambam is one of the few hospitals where a municipal inspector hands out fines for smoking in places where it is forbidden. The fine is NIS 1,000 per violation, Beyar said, adding that he knows the public will obviously continue to buy tobacco outside the campus and try to use the products inside, “but we are planning future steps” to prevent violations.

National Council for the Prevention of Smoking head Amos Hausner said he congratulated Rambam, as a hospital that does healing “must not sell death.” But Hausner has said many times that hospitals and other public facilities should not allow indoor smoking rooms at all, and all who insist on smoking should go outdoors. Hausner also called on the IDF to ban the sale of tobacco products in canteens and other facilities.

“If they have to, soldiers can bring them from home but they must not smoke indoors,” he said.

He noted his disappointment that many religiously observant people still smoke even though very prominent rabbis, including Rabbi Shlomo Wosner of Bnei Brak, have ruled that it is forbidden to sell tobacco products, let alone use them.

Supermarket and cellular phone service mogul Rami Levy, who said he personally doesn’t smoke or allow close family members to do so, lets his mehadrin (Eda Haredit kashrut-supervised) supermarket in Jerusalem’s Givat Shaul rent out a tobacco shop inside the building that the Eda Haredit rabbis have not prohibited from operating even though it is widely recognized that smoking violates Jewish law.

When asked over a year ago why he doesn’t bar the sale of tobacco in his entire chain, but especially in the mehadrin store, Levy said it would take “a year” for the expiration of the contract with the company that owns all the shops and vending machines in his chain. But on Monday, he told the Post the contracting company took an option to continue supplying tobacco products to his chain, thus lengthening the contract for two years. Levy promised, however, that he will stop all tobacco sales in his stores in another two years when the contract with the supplying company runs out.

On December 21, the ministry made it illegal to install cigarette vending machines within 1,000 meters of schools and other educational institutions. Starting January 1, 2014, the use of tobacco vending machines will be completely barred, giving the vendors time to “make up their investments” in the machines, even though they could easily be retrofitted immediately to sell other products.

'Inaction' On Smoking Violations Questioned

A senator has scored the Inter-Agency Committee on Tobacco (IAC-T) for its dismal performance in ensuring that the law regulating smoking in the country is strictly enforced.

Sen. Pilar “Pia” Cayetano said the lead agency of the IAC-T, the Department of Trade and Industry (DTI), together with the Department of Health and the Philippine Tobacco Institute, the organization representing tobacco companies, has so far reported only one violation or case filed for the period of January to September 2011.

For the past two years, the IAC-T has also only conducted four meetings, two for each year discussing the agency’s exclusive jurisdiction over tobacco products; the country’s representation to the Framework Convention on Tobacco Control (FCTC) negotiations on Articles 9 and 10; and clarification whether the DTI is the lead agency on the guidelines on Articles 9 and 10 of the FCTC.

Yet the number of people violating Republic Act 9211 or the Tobacco Regulation Act of 2003 is increasing despite campaigns being done by the government.

“I believe there are more provisions of the law that are being violated out there. Is the slow action of the IAC-T because it has not received any reports of violations? Or is it because the IAC-T failed to conduct aggressive information campaigns as to the availability of their hotlines? Or is it simply because they refuse to act on such reports of violations?” said Cayetano, who chairs the Senate committee on health and demography.

“I reiterate my strict directive for the IAC-T to do its job and act on these reports of violations. I task them to convene a meeting immediately and take up reported violations and act upon them,” Cayetano said.

As part of their mandate under the Local Government Code, Cayetano said local government units (LGU) likewise, should see to it that establishments and malls within their jurisdiction are strictly enforcing Section 6 of the law which provides a designated area for smokers.

“May I point out that among the penalties for violations of the law is the cancellation of their business permit,” she said.

She urged the Senate to exercise its oversight function in ensuring that the provisions of the law are strictly being implemented.

“I trust that we will show the Filipinos that the law is equally applied, that none of us is above the law. I trust that the Senate will take the necessary corrective measures to ensure that we strictly complied with the law that we have enacted,” she said.

Not hiring smokers crosses privacy line

Baylor Health Care System, one of the Dallas area's largest employers, has taken several savvy steps in its fight against smoking. It has offered free smoking-cessation programs to workers, made its campus smoke-free and slapped a health insurance surcharge on employees who smoke.

But on Jan. 1, Baylor went a step too far: It stopped hiring anyone who smokes at work — or anywhere else. Treating smoking, in essence, like illegal drug use takes Baylor and an increasing number of other employers down a dangerous road, one that extends far too deeply into the private lives of prospective workers.

Baylor says that as a health care organization, it wants to practice what it preaches: discouraging one of the nation's deadliest health habits. But such practices are not confined to the health care industry, and they raise a broader issue: If employers routinely reject people who engage in risky, but legal, behavior on their own time, what about such things as overeating or drinking too much alcohol? If smoker bans reduce health care expenses, cost-conscious employers might be tempted to stake out new and even more intrusive territory under the "wellness program" banner. A bit further down the road lies hiring based on genetics. In that world, inheriting a gene that shows a predisposition to a costly disease could cost you a job.

A decade ago, bans on hiring smokers were rare. A few companies — including Alaska Airlines, Turner Broadcasting, Florida's Gulf Power and some law enforcement agencies — were among the early adopters. The trend led 29 states to pass laws protecting smokers from what lawmakers saw as workplace discrimination.

While no one keeps count, the practice appears to be spreading in the other 21 states. At Weyco Inc., a Michigan medical-benefits administrator, four employees quit when they refused to submit to the company's no-smoker policy. Since 2007, the Cleveland Clinic— which has 40,000 employees and hires 5,000 a year — hasn't hired anyone who tests positive for nicotine. Starting this Wednesday, Pennsylvania's Geisinger Health System, which has 15,000 employees, won't hire smokers.
At least health care providers can assert that the bans are related to their medical missions. But what about other companies? Scotts Co., which makes lawn and garden supplies, made headlines in 2006 when it was sued by a new hire who was fired after testing positive for nicotine; Scotts' policy was upheld by a federal court in Boston. Atlanta-based Georgia Power stopped hiring smokers in 2009.

Even the Hollywood Casino in Toledo, Ohio, set to open this year, tells smokers they need not apply for employment. This means House Speaker John Boehner, a smoker who is second in line to the presidency, couldn't get a job at a casino in his home state.
In a nation where 55% of workers get their insurance through their employers, and where employers' insurance costs have more than doubled in just a decade, companies have ample reason to cut costs and keep employees healthy. They also deserve great latitude in hiring, which makes legislation problematic. But intruding this deeply into people's private lives raises questions that bear scrutiny.
Companies can charge smokers more for health coverage or ban smoking on the job. But punishing people for using a legal product on their own time crosses a troubling line.

Program helps smokers butt out

THE theme for this year's national Non-Smoking Week, Jan 15-21, is breaking up is hard to do, but breaking up with tobacco this new year is easier for British Columbians thanks to B.C.'s Smoking Cessation Program.

According to a written statement, since the program launched in September 2011, more than 63,000 B.C. residents have called 811 for free access to nicotine replacement therapies. Approximately 37,000 of these have been requests for first-time orders, representing almost seven per cent of B.C. smokers, 24,000 have been requests for refill orders and more than 19,000 people have obtained a prescription smoking cessation drug while visiting their physician for another reason.

The Smoking Cessation Program helps people stop smoking or using other tobacco products by assisting with the cost of smoking cessation aids. Once each calendar year, B.C. residents enrolled with the Medical Services Plan can receive PharmaCare coverage of a single continuous course of treatment of a prescription smoking cessation drug or a free 12-week supply of a nicotine replacement gum or patches. After registering for the program, British Columbians can receive further support in quitting smoking from QuitNow Services.

Virginia lawmaker proposes tobacco tax increase, car tax cut

Health activists who hope to curb smoking in Virginia have a new strategy, and it involves cutting the car tax. A Delegate from northern Virginia has introduced a bill that would raise the state's cigarette tax by more than $1.00 a pack, and devote most of the proceeds to car tax relief.

Richmonder Jerrell Adkins says his cigarettes are already too expensive, and a $1.15 increase in the state cigarette tax would persuade him to quit. "That's too much to be paying," Adkins told News7. "If they're only four dollars now, four dollars is already too much," he said.

That's exactly what members of the Tobacco Free Alliance are hoping to hear.

Jann Balmer is the chairman of the group's Virginia organization. "Smoking and tobacco affect every organ in your body and what we want is for people to be healthy," she said Tuesday morning.

Arlington Delegate Patrick Hope has introduced legislation that would raise the state tobacco tax to the national average, $1.45 a pack. Some of the money would pay for prevention programs, but most, more than $250 million, would go toward cutting the unpopular car tax.
"If you have a $15,000 car, you're probably writing a tax bill of nearly $200," Hope said after a Richmond news conference. "This would cut it in half. And you have multiple cars. This is real relief for real families."

A lawmaker who represents tobacco country and opposes the legislation says the bill would harm another group of Virginians.

"We've got to protect our tobacco farmers and the ones who've remained in the trade in agriculture in our area," said Senator Bill Stanley, "and so I certainly want to do whatever I can to protect the farmer."

Proposals to raise Virginia's tobacco tax have repeatedly failed in the General Assembly, but supporters are hoping a new approach will give the idea some fresh momentum in 2012.

B D College to be declared 'no-smoking zone' from R-Day

The B D College campus would be declared a "no-smoking zone" from January 26. A decision in this regard has been taken by the college authorities to maintain academic ambience on the campus. College principal B N Ojha said teachers and students would be barred from smoking, chewing betel and consuming any tobacco products once the new regulation is imposed.

The principal said the college has already announced to maintain a dress code for boys and girls from February. Use of cellphones by students has also been banned on the campus. The college will realize fine from students found using cellphones on the campus during the teaching hours, he said.

PG teaching: B D college will start postgraduate teaching in commerce from Tuesday. The PG teaching in commerce used to be held at the college in the past. However, it was withdrawn by the university due to some unavoidable reasons. The PG teaching in commerce would serve the purpose of students, particularly girls of local areas, who go elsewhere to pursue M Com course, Ojha said.

Jubilee Bhawan: A N College is building Jubilee Bhawan on its sprawling campus. The building will be completed soon. It will house the administrative block of the college, college principal Haridwar Singh said. According to him, two more buildings for a girls' hostel and BEd students are also being constructed on the college campus. These buildings would give a new look to the college on their completion, he said.