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The American Association of Health Plan’s (AAHP) Awards Programme, Managed Care Achievements in Tobacco Control, is an opportunity to recognise health plans’ efforts to increase interest in and capacity for reducing the health problems caused by tobacco. The awards recognise and honor the innovative and practical strategies, practices, programmes, and policies used by health plans to establish effective tobacco prevention and cessation interventions.

 The Managed Care Achievements in Tobacco Control awards programme encourages health plans to build upon the Agency for Health Care Policy and Research’s (AHCPR) guideline on smoking cessation, using evidence-based standards and the demonstrated strategies which are outlined in the guideline.1 By honouring these exceptional efforts, AAHP demonstrates the commitment of health plans to promote widespread adoption of effective tobacco control interventions into routine clinical practice.

Tobacco control intervention opportunities are diverse; they can range from clinical, outpatient counselling in community settings, to behavioural and pharmacological cessation programmes—they can involve physicians, allied health professionals, and employers. Aspiring toward national standards for tobacco control requires creative solutions which are adaptable and reproducible in a variety of managed care settings, as demonstrated by the Managed Care Achievements in Tobacco Control award winners. The following award-winning examples (abstracts of which are published here) will assist in identifying barriers and developing resourceful programmes to improve smoking cessation rates within organisations, as well as the community at large. The American Association of Health Plans and the Addressing Tobacco in Managed Care National Technical Assistance Office (NTAO) believe that by sharing these programmes and methods we will be one step closer to conquering the leading preventable cause of illness and death in the United States—tobacco use.

The awards programme is one of many national activities supported by the NTAO of the Robert Wood Johnson Foundation’s Addressing Tobacco in Managed Care (ATMC) programme. The ATMC programme promotes the study and dissemination of policies and practices which reduce tobacco use among managed care subscribers. The NTAO is a collaborative effort directed by the American Association of Health Plans with Health Alliance Plan and the Prudential Center for Health Care Research.

Award applications were reviewed by an independent panel of experts in tobacco control and quality improvement practices and programmes. AAHP thanks the panel for their assistance in the review process, and the Health Alliance Plan component of the NTAO for managing the awards process.

Glaxo Wellcome joins AAHP in this commitment to tobacco cessation and prevention and is proud to support the Managed Care Achievements in Tobacco Control awards programme through an unrestricted educational grant.

The Managed Care Achievements in Tobacco Control awards programme is an annual event. Nomination materials for the 1999 awards will be available in January 1999 from the American Association of Health Plans (tel +1 202 778 3239; dskripak{at}; <> listed under “Initiatives”). An organisation must be a member of the AAHP to be nominated

Award categories


This award is presented to health plans for implementing creative programmes, strategies, interventions or policies which address tobacco prevention and/or smoking cessation, in the adult population. Examples include: creative use of resources to overcome specific barriers to implementation of the intervention; effective approaches applied to tracking, monitoring, and collecting data; provider or adult education and incentives; worksite programmes; diffusion of the intervention to new communities; and outreach to adult populations.


This award is presented to health plans for implementing programmes and/or strategies aimed at young people or for directly shaping policies focused on reducing use in the young, exposure or access to tobacco products. Examples include: implementation of public campaigns; school-based interventions; education of providers or young people; direct involvement in policy development related to access; outreach to young people in the community at large; effective methods of tracking, monitoring, follow up and data collection.


This award is presented to health plans and their primary public partners who, together, have forged a true working relationship to reduce tobacco use rates within the health plan member population and/or larger community. Applicants were asked to describe the type of relationship and type of organisation(s) with which they are collaborating. Joint collaborations that include state and/or local health departments or agencies, as well as other public or private corporations and community groups, are of special interest.


This award is presented to a health plan for implementing notable tobacco cessation and/or prevention strategies, interventions or programmes directed toward a specific, special population, including (but not limited to) pregnant women, minorities, Medicare/seniors, Medicaid, women, or underserved populations. Examples include: needs assessment and programme design rationale which led to the intervention; creative use of resources to overcome barriers related to reaching the target population; special provider or other training methods involved with programme implementation; and effective methods of data collection, tracking, monitoring and follow up.

The award-winning health plans used numerous strategies and processes to design and implement their tobacco control efforts. Most of the interventions are replicable in a variety of managed care models and settings.

Adult tobacco control initiatives category


Group Health Cooperative of Puget Sound, Seattle, Washington

For more information contact:

Rachel Grossman

Tobacco Use Roadmap Coordinator

+1 206 442 5242;


Programme overview—Since 1992, tobacco use reduction has been the number one prevention priority at Group Health Cooperative of Puget Sound (Seattle, Washington). The Cooperative’s long-term goal is to decrease the prevalence of tobacco use among adults to 12.5% in the year 2000 (from 20% in 1990). To do so, Group Health has implemented a comprehensive approach to tobacco use reduction.

The following are components of its successful, multifaceted programme.

  • Top-level organisational support for tobacco reduction initiatives

  • Dedicated resources to support staff and ongoing planning efforts

  • Development and implementation of a tobacco use clinical guideline in every clinic and hospital

  • Offering, as a fully covered benefit, a proven tobacco cessation programme which incorporates behavioural and adjunct pharmacological therapies

  • Quarterly measurement and reporting, at the provider and clinic-levels, of medical record documentation of tobacco status and provider advice to quit

  • Recognition of clinics achieving performance targets and dissemination of “best practices”

  • Strong patient education materials and repetitive population-based messages in Northwest Health, a publication for Group Health members.

Results—Tobacco use prevalence among Group Health’s adult members has decreased to 16% in 1997 from 20% in 1990; “chart documentation of identification of tobacco status” at primary care visits has risen from 56% in 1994 to 98% in 1997; “chart documentation of advice to quit” given to tobacco users at a primary care visit has increased from 20% in 1994 to 52% in 1997; and enrolment in the Free & Clear tobacco cessation programme has grown from 200 participants in 1992 to 3100 in 1997.

Adult tobacco control initiatives category


Kaiser Permanente-Northwest

For more information contact:

Jack Hollis

Associate Director, Center for Health Research

+1 503 335 6754;


Programme overview—TRAC (TobaccoReduction,Assessment, andCare) is an office-based systems approach designed to overcome many barriers to delivering effective tobacco interventions in a busy managed care setting. Kaiser Permanente Northwest (KPNW), a 430 000 member group-model health management organisation, is now implementing the TRAC team approach for delivering the “4As” (ask, advise, assist, and arrange) throughout its adult primary care facilities.

Results—Post-visit surveys of 20 372 randomly chosen patients in five TRAC and five non-TRAC facilities showed that implementation increased assessment (59%vs 54%, p<0.001) and clinician advice (72% vs 59%, p<0.001) at the visit. Post-visit stage-of-change also improved significantly more in TRAC facilities (p<0.001). Virtually all smokers (96%) reported that staff “should encourage smoking patients to quit and offer assistance to those who want to quit,” and visit satisfaction was higher for those who reported clinician advice than those who did not (4.2vs 3.9 on five-point scale, p<0.001). Intervention efforts, and especially documentation practices, fell over time. A later chart review showed that 90% of patients had been assessed at some point and 25% of smokers with visits in a six-month period had documentation of advice over six months.

Conclusions—Though implementation was successful initially, maintaining the programme required additional system-level supports. All remaining facilities have now implemented TRAC, and tobacco control is one of the eight high priority clinical quality targets. Prompting and documentation have been integrated into the electronic medical record, monitoring and monthly feedback continue, and compensation is now tied to performance throughout the organisation.

Youth/adolescent tobacco control initiatives category


Kaiser Permanente-Northeast, Williston, Vermont

For more information contact:

Paul J Reiss

Associate Medical Director—Vermont

+1 802 878 2334;


Programme overview—Kaiser Permanente Northeast/Community Health Plan (KPNE/CHP) took a major leadership role in preventing tobacco use in young people by implementing a programme called “Tar Wars” in Vermont. Providing healthcare coverage for a quarter of Vermonters, KPNE/CHP realised that major lifestyle changes in their insured population would be possible only with a change in the community at large. The standardised Tar Wars’ fifth grade curriculum was adapted and offered to schools. The programme grew from 20 schools and 20 presenters in 1995 to 96 schools (41% of Vermont schools) and 74 presenters in 1998. The Tar Wars programme became a vehicle to join clinicians, educators, businesses, legislators, and the media in activities towards prevention in the young. The programme teaches short-term tobacco effects, advertising influences, and true tobacco use prevalence.

Results—The programme’s effectiveness was shown by significant differences in young people’s estimates of adult smoking prevalence before the programme was given (71.5%), and then one year later (54.5%) compared with classmate controls (66.5%). The message “most people don’t smoke” was used in customised classroom posters, “cool” teeshirts, and take-home factsheets. The programme is believed to have contributed to the unique stabilisation of smoking rates in the young in Vermont. The institutionalisation of Tar Wars and cross-departmental involvement have created a sustainable model for a community/school intervention that other health maintenance organisations (HMOs) could readily emulate.

Youth/adolescent tobacco control initiatives category


Allina Health System,

Minneapolis, Minnesota

For more information contact:

Robert J Jeddeloh

Director, Care Systems Innovation

+1 612 992 3907;


Programme overview—Allina Health System, in partnership with the National Theater for Children, has developed and presented in the form of interactive live theatre, developmentally and culturally appropriate plays about prevention of tobacco use. These plays have been presented to 160 elementary schools, with approximate total enrolment of 48 000 students, in Minneapolis/St Paul and greater Minnesota. Two plays, one for grades kindergarten through three (ages 5–8) and the other for grades four through six (ages 9–12) target known, age-specific, psychosocial risk factors for tobacco use onset. The plays seek to enhance knowledge about the short-term and long-term consequences of tobacco use and to equip children to resist tobacco use. In addition to the live presentation, a related classroom curriculum and student workbooks are offered.

Conclusions—Approximately 93% of participating teachers report using the classroom component. An extensive evaluation process has been conducted to measure the impact and effectiveness of this programme in knowledge enhancement and the delay of tobacco use onset. An increase of 10% of students report that they “will never try a cigarette” after viewing the plays. Gains were also found to be statistically significant on several other factors.

Private/public partnerships in tobacco control category


Blue Cross and Blue Shield of Minnesota, St Paul, Minnesota

For more information contact:

Daniel Johnson

Community Affairs Manager

+1 651 456 1580;


Programme overview—Blue Cross and Blue Shield (BC/BS) of Minnesota partnered with the state attorney general’s office to attack tobacco use on two fronts. First, the plan brought a landmark lawsuit against tobacco companies for violating Minnesota’s antitrust and consumer protection laws. Second, BC/BS, in partnership with the attorney general and others, developedMinnesota decides: a community blueprint for tobacco reduction. The blueprint is the most comprehensive set of recommendations to reduce tobacco ever introduced in Minnesota.

Conclusion—Minnesota Blue Cross was the first health plan to sue—and to be victorious—in the fight against “Big Tobacco”. Blue Cross and the state accomplished the landmark lawsuit’s original goals: the truth about the tobacco industry’s deceit and conspiracy has been disclosed; how tobacco is marketed to Minnesota children has forever changed; and the industry has been held financially accountable for its conduct.Minnesota decidesbrought together people from all walks of life, in grassroots forums, to discuss ways to reduce tobacco use in their community. The result is a 72-page blueprint that is being used by Minnesota communities to tackle tobacco use, and it is shaping the current debate on how state settlement proceeds should be spent.

Tobacco control in special populations category


Healthsource Maine, Inc.

For more information contact:

Dean Paterson

Manager, Health Education Department

+1 207 865 5126;


Programme overview—Healthsource Maine, Inc. has developed an innovative telephone smoking cessation programme offered to rural managed care subscribers and dependents. The study includes 321 members using nicotine replacement therapy who are enrolled in the Healthsource Maine telephone counselling programme. The project evaluated quit rates, cost benefit to employers, and relative severity index.

Results—39% of the population had quit smoking at the six-month measurement with a 28% quit rate at 24 months. A cost benefit of $15–50 per member per month was determined.

Conclusions—Telephone-based smoking cessation counselling is an effective counselling method for persons who are ready to quit smoking, and have the benefit of nicotine replacement therapy, and whose health plans cover the cost of the counselling. This is an especially efficacious methodology with a rural population.


Tobacco Control <>

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     There is also a longer version of the “Play It Again” section of Tobacco Controlthat was published in the Winter 1996 issue of the journal, cataloguing tobacco-related quotes made during the 1996 United States presidential campaign.

    A hotlink gives access to:

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  • Sponsored by the National Technical Assistance Office of the Robert Wood Johnson Foundation’s Addressing Tobacco in Managed Care programme.For more information on the Addressing Tobacco in Managed Care programme and the activities of the National Technical Assistance Office (NTAO), contact any of the NTAO programme managers:

    Abby Rosenthal

    +1 313 874 6813;


    Linda Schuessler

    +1 770 801 7649;


    Danielle Skripak,

    +1 202 778 3239;


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