Improve Access to Cessation Treatment

Washington State has received an F grade for many years in the American Lung Association’s annual analysis of overall access to cessation services.⁷ Quitting nicotine and commercial tobacco provides huge health benefits to the individual – as well as huge savings in healthcare costs. Despite these advantages, little funding is dedicated to providing comprehensive and evidence-based commercial tobacco cessation services for Washington state residents.

Priority Groups

Rates of commercial tobacco use and resulting tobacco-related diseases are higher in some populations. These groups are often targeted by the tobacco industry and also disproportionately impacted by a variety of adverse societal factors. Priority groups have been targeted by the tobacco industry based on:

• race/ethnicity - such as marketing mentholated products to Black neighborhoods that make it harder to quit
• socioeconomic status - through strategies like concentrating tobacco shops and convenience stores in lower income communities
• gender identity and sexual orientation - through strategies like special product promotions to the LGBTQ+ community
• age - including targeting youth with e-cigarette advertisements¹¹

Because of these factors, these groups tend to have higher rates of commercial tobacco product use, while also experiencing more barriers to accessing cessation services. These barriers include not having access to services that are culturally appropriate or in their preferred language, relying on public insurance that doesn’t fully cover cessation services, not being advised to quit by a healthcare professional, and social pressure to use due to widespread community use.

Quitline Information

Washington State’s Quitline is a critical basic service that connects people to cessation services. Uninsured and underinsured Washingtonians are typically eligible for at least five counseling calls and two weeks of free nicotine replacement therapy (NRT), through CDC grant funding. However, many people need NRT support for longer periods of time to successfully end their nicotine dependence, from 12 weeks to a year. Currently, the duration of free NRT products from the WA Quitline depends on available funding as well as the number of people requesting cessation support. This limits the program’s ability to help everyone who wants to quit nicotine.

• Profile of Services Offered by WA Quitline (North American Quitline Consortium)
• Utilization Dashboard (WA Department of Health)

Accessibility to Services

A robust and comprehensive tobacco cessation service should be easily accessible and as barrier-free as possible. Key factors to consider include physical location and ease of access (e.g. virtual/online offerings or integrated into existing health system), language (e.g. services available in a variety of languages), cultural considerations (e.g. ensure facilitator is familiar with the unique needs of the population being served), and cost (e.g. covered by health insurance or free of charge).⁹

Limitations to insurance coverage and costs are often a barrier to effective cessation services. Learn more about insurance coverage:

• Federal Coverage (American Lung Association)
• WA State Coverage Data (American Lung Association)
• Coverage by Insurance Status (WA Department of Health)

I’m Ready to Quit

We have compiled a directory of state and county-specific quitting resources for people who use commercial tobacco products and would like to quit.

All types of health professionals can play a critical role in connecting patients to cessation resources and counseling them on quitting. It’s important for all providers to stay up-to-date on best practices and to continue assessing all patients for nicotine dependence. The following are trainings, practice tools, and resources to support clinicians:

• Tobacco Cessation Training Module (Public Health-Seattle King County): 90-minute, self-guided training ​​on using motivational interviewing techniques to encourage, empower, and assist people as they move toward a successful quit attempt. Email Nori de la Pena to register.
• Ask, Advise, Refer to Quit Don’t Switch (American Lung Association): online training that gives providers tools and strategies for initiating a brief tobacco intervention and is based on CDC’s Ask-Advise-Refer model. Use the Registration link to sign up.
• Practice Tools to Address Tobacco Use and Secondhand Smoke Exposure (American Academy of Pediatrics): information and guidance for pediatricians prescribing nicotine replacement therapy (NRT) to youth
• Smoking Cessation Leadership Center (University of California San Francisco): webinars, publications, toolkits, and fact sheets/guides all available to providers
• Accredited Programs to become a Certified Tobacco Treatment Specialist (CTTS) (Council for Tobacco Treatment Training Programs)

For Pediatricians:

• Help Kids Quit clinical tool an online tool for healthcare providers that can be used to screen youth age 11+ for commercial tobacco use at each clinical encounter. (American Academy of Pediatrics)
• American Academy of Pediatrics' resources for youth tobacco control and prevention. AAP provides many evidence-based online resources and toolkits for pediatricians.
• Nicotine Replacement Therapy and Adolescent Patients from the American Academy of Pediatricians. Explains off-label prescribing of NRTs to help patients under 18 years old.

For Dentists:

• Implementing & Fostering QuitLine Referrals: a toolkit/guide from the American Dental Association on how Oral Health Professionals can connect patients to the QuitLine and other evidence-based cessation resources.

Changes need to be made to improve accessibility and use of tobacco cessation services for all Washington residents. A few potential ways to improve cessation treatment include:

• Restoring state investment in cessation services to better meet the needs of communities more impacted by commercial tobacco use.
• Requiring health insurance companies to reimburse all providers for counseling and cover all seven (7) FDA-approved medications;
• Ensuring health systems integrate comprehensive screening and treatment protocols, refer individuals to the WA State Quitline and other cessation services, and adopt tobacco-free campuses and policies;
• Training providers and healthcare professionals to refer patients to the WA State Quitline and other cessation services, promote tobacco education and cessation campaigns, and seek additional training and certification.¹⁰

• Participate in Washington Breathes’ ‘Improving Access to Cessation Treatment’ workgroup
• Accredited Programs to become a Certified Tobacco Treatment Specialist (CTTS) (Council for Tobacco Treatment Training Programs)
• Develop or engage in local education campaigns linked to national events, including:
  • No Menthol Sunday: annual event each May
  • World No Tobacco Day: every year on May 31st
  • The Great American Smokeout: 3rd Thursday each November
• Share resources with family members, friends, and teens:
  • WA Breathes list of Cessation Support Services
  • How to Help Someone Quit Smoking (American Cancer Society)
  • For teens who vape, text DITCHJUUL to 88709: created by The Truth Initiative.
  • N-O-T, Not On Tobacco (American Lung Association): Teen Smoking and Vaping Cessation program with trained facilitators who deliver structured curriculum in schools or community-based settings.