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Maryland recently ranked third-worst in the country for the lack of assistance it offers its residents to quit smoking, according to the American Lung Association’s “Helping Smokers Quit: Tobacco Cessation Coverage 2011” report.

But with so many smoking cessation programs available in Charles, Calvert and St. Mary’s counties, the news comes as a surprise to the citizens of Southern Maryland.

“It’s true that Maryland fell into the bottom five, but despite that fact, Maryland actually has one of the lower total smoking rates in the country,” said Kimberly Williams, manager of advocacy and communications for the American Lung Association. “So why is there this difference? There are definitely cessation activities going on the local level in the state, but our report looks more at the insurance side of things on the state level.”

According to the ALA, Maryland government presently offers no tobacco cessation benefit to state employees. Further, the Maryland quit line is only funded at a rate of $1.20 per smoker for fiscal 2012, which is a fraction of the national minimum standard of $10.53 that the Centers for Disease Control and Prevention recommends to reach an adequate number of smokers in every state. Some low-income Medicaid enrollees in the state do have access to tobacco cessation treatment, but it is not guaranteed for all Medicaid enrollees.

“On top of that, the CDC’s recommendation for tobacco cessation and control programs is $63.3 million per state, but Maryland only invests $4.3 million on top of the $1.7 million it receives in federal funding,” Williams said. These numbers are both far below where they need to be, Williams said, though there is no legal penalty for falling short of the suggested minimums. Georgia, Louisiana, Alabama and New Jersey also are cited for weak efforts to encourage smokers to quit.

And in its 10th annual State of Tobacco Control report this year, the Lung Association graded all 50 states and the District of Columbia on four proven policies to save lives and cut health care costs. Maryland got an F on tobacco prevention and control program funding; and A on smoke-free air laws; a C on cigarette tax rates; and an F on coverage of cessation treatments and services. In the assessment, six states — Alabama, Mississippi, Missouri, South Carolina, Virginia and West Virginia — received all Fs. Only Delaware, Hawaii, Maine and Oklahoma received all passing grades. No state received straight As, though 2011’s five most quit-friendly states were Maine, North Dakota, Delaware, Oklahoma and Wyoming.

On the state level“Maryland has a very strong smoke-free law, in reality, so it makes it more difficult to smoke in public, which discourages people from doing it in the first place,” hence the lower smoking rate, Williams said. “Then, Maryland’s cigarette tax falls in around $2, which is decent but could definitely be higher. But that tax helps deter people on a financial level from smoking.”

But that’s not enough, Williams said.

“Smoking is never an easy habit to break, so that’s why we need Medicaid to step up and provide a comprehensive coverage plan in Maryland geared toward smoking cessation for its state employees,” she said. “Typically, I see Maryland as a state that holds up the health of the population and sees it as a top priority, so it’s just surprising that even though there is that support in the general culture to be mindful of your health, there’s nothing in regard to comprehensive coverage — be it for gum, patches, nasal sprays, lozenges, medications, group or individual therapy. It’s important that Maryland has preventative programs in place, sure, but it’s equally important to see that there is an option for those already smoking to have the chance to quit or get help on the insurance level. That’s what makes a good quit-friendly state.”

In Southern Maryland

According to the CDC, smoking is the leading preventable cause of illness and premature death, claiming more than 443,000 lives annually because it directly increases the user’s risk of heart disease, stroke, emphysema and a variety of cancers. A variety of smoking cessation classes are offered in the tri-county area, but quitting is easier said than done, most say.

“There’s still a lot of misunderstandings about quitting smoking,” said Patrick O’Malley, a certified tobacco treatment specialist with the Calvert County Health Department. “People always want to use the term ‘willpower.’ But it’s not about willpower; it’s about what you want. Addiction is addiction is addiction — it’s a disease of desire. Do you want to quit smoking or do you not? That’s where the commitment kicks in.”

O’Malley teaches an eight-week smoking cessation program offered at noon and 6 p.m. each Thursday at the Holiday Inn Express in Prince Frederick, where he said treatment focuses more on changing smokers’ habits.

“Our program is different because it addresses both the addiction and the behavior,” he said. “We offer participants the nicotine replacement patch and Chantix as per their physician’s recommendation, but the patch and the pill only get you so far with the addiction itself.

“It’s just that the behavior is so engrained — most have started smoking very young and it’s just become a part of them and it’s really hard for them to get away from it. ... But you have to make a firm decision and stay committed.”

In Charles County, the ALA’s Freedom From Smoking program is offered three times a year in 10-week increments, said Mary Beth Klick, community health educator for tobacco prevention and smoking cessation programs with the Charles County Health Department.

“It’s a free program that we offer starting in January, April and September, during which we consult with each client, establish their smoking history and find out exactly why they are trying to quit,” she said.

Klick said many clients respond with health-related concerns, but most make it clear that the financial strain of supporting the habit is a major factor.

“They also talk about how hard it is nowadays to smoke in public,” Klick said, noting that most restaurants, bars, hospital grounds and other public access areas in the state have cracked down on their no-smoking policies.

“That makes change happen,” Klick said, “and the more confining we make it, the more people are pushed to quit.”

In addition, Civista Health provides a list of community resources for quitting smoking to all of its patients who identify themselves as smokers when they are admitted to the hospital as well as to community members who contact Civista through its website or community resource line, said Joyce Riggs, director of community development and planning for Civista Health.

And in St. Mary’s County, the health department’s wellness and health promotion program offers a free tobacco use prevention course, available in eight-week increments throughout the year, said Jane Dodds, a nurse with the health department.

Participants must be at least 18 years old and St. Mary’s residents to attend, though there are case-by-case exceptions. The classes meet once a week, with the next session set to run May 1 through June 19. Committed participants also are offered Chantix and free nicotine patches, which they can pick up at Reynolds Pharmacy in Leonardtown. “It is very hard to quit here in St. Mary’s, as it’s become a way of life,” Dodds said, noting that many area residents grew up around tobacco fields and even helped harvest it at one time or another. But Dodds said that the most common arguments she hears include the ever-popular “If it’s so bad, then why isn’t it illegal?” question alongside the “life is just so stressful” excuse.

“But the biggest reason is it’s addictive,” Dodds said. “People are addicted to nicotine just like they are addicted to alcohol or other drugs.”

MedStar St. Mary’s Hospital offers a free smoking cessation program exclusively for hospital employees, where one-on-one counseling sessions can be arranged with Karen McCleaf, a nurse practitioner in the hospital’s occupational health department.

“We offer these one-on-one sessions because to some people, this is an extremely private matter,” McCleaf said. “And if they need medication regarding smoking cessation, be it prescription or not, I can write them an order for it and they can pick it up at our pharmacy free of charge.” Calvert Memorial Hospital offers a similar program for its employees as well.

And with such a large portion of St. Mary’s County representing the military, there are options for service members and their families available through Tricare, as the company offers its beneficiaries in the North, South and West regions who are not eligible for Medicare a 24/7 help line that allows them to speak with a trained tobacco quit coach.

Looking aheadWilliams said she and other advocates are working to increase cigarette and other tobacco taxes, allowing some of the proceeds to trickle back into anti-tobacco programs in the state.

“We’ve got to angle ourselves now toward hitting these other tobacco products with higher taxes, because that’s what people are turning to since it’s so much cheaper” than cigarettes, she said.

Dodds added that she believes the state needs more legislators who will deny big tobacco companies the right to advertise in Maryland. “The tobacco industry spends over $12 billion in advertising annually,” she said, “and it’s estimated that the amount spent in Maryland is $144 million. We spend less than 10 percent of that on cessation and prevention. We know that tobacco is bad for us. ... But we have to get involved and voice our opinions to our local, state and federal legislators” to establish anything concrete.

“It’s more addictive than heroine and cocaine according to the ALA, but the fact that you can get it legally provides that ‘fix’ some people are looking for,” McCleaf added. “But you have to rise above the addiction and determine that you want to quit; when you come to the point where you realize that you need to do it for yourself, that’s when you make it happen.”

To learn more

For more information on the St. Mary’s County Health Department’s tobacco use prevention program, call Jane Dodds at 301-475-4074.

To contact Patrick O’Malley with the Calvert County Health Department’s smoking cessation program, call 410-535-5400. “Quit Kits” are also available.

For the Charles County program, contact Mary Beth Klick at 301-609-6932.

For Civista Medical Center, call 301-609-4000.

The Tricare Quitline (North Region) can be reached 24/7 at 866-459-8766, and the Maryland Tobacco Quitline can be reached at 1-800-QUIT NOW.