Strengthening Our Commitment to Help End Tobacco Use

Five Years Since Exiting Tobacco, Focus Expanding to Other Challenges

This article was authored by CVS Health Chief Medical Officer Troyen Brennan, M.D., M.P.H., and Eileen Howard Boone, Senior Vice President of Corporate Social Responsibility & Philanthropy for CVS Health. 

Five years ago, we decided to stop selling cigarettes and tobacco products in all CVS Pharmacy locations. It was the first step toward building an innovative health care company driven by a purpose — helping people on their path to better health. Since then, CVS Health and the CVS Health Foundation announced a multi-year $50 million Be The First initiative to help create the first tobacco-free generation.

On the anniversary of our original decision, we are expanding the program to tackle the growing problem of youth vaping with additional investments and new partners. We’re also bringing our smoking cessation expertise to areas across our businesses, with an expanded focus in 2020 on increasing effective smoking cessation approaches in Medicaid plans, including in Aetna Better Health managed Medicaid plans and together with CVS Caremark clients interested in creating or expanding smoking cession efforts for their Medicaid members.

Demonstrable Positive Impact on Tobacco Use

Our decision to exit tobacco led to a meaningful and measurable decline in cigarette smoking. Within 12 months, in states where CVS Pharmacy had at least 15 percent of the market share, consumers had purchased 100 million fewer packs of cigarettes, according to research we published in the American Journal of Public Health (AJPH) in 2017.https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2016.303612?journalCode=ajph Households that purchased cigarettes exclusively at CVS Pharmacy were 38 percent more likely to stop buying cigarettes, and those consumers who bought more cigarettes (>3 packs a month) were more than twice as likely to stop buying them.1

Within 12 months of ending cigarette and tobacco product sales in all CVS Pharmacy locations: Consumers purchased 100M fewer packs of cigarettes.In states where CVS Pharmacy had at least 15 percent of the market share.

These findings clearly indicate the positive public health impact of our decision. It is also significant because even though cigarette smoking has been on the decline, many consumers still struggle with nicotine use. In a recent CVS Health research study, 39 percent of consumers said they, or a family member or friend, have struggled with nicotine use — such as cigarettes or vaping — in the past five years. Of consumers aged 35–50, nearly half — 45 percent — said they struggle with nicotine use. Forty percent of millennials said they did as well.

Need for Greater Action on Tobacco

Cigarette smoking continues to be responsible for more than 480,000 deaths per year in the U.S.3 The total economic cost of smoking is more than $300 billion a year.https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm Clearly, more needs to be done to help our country quit tobacco. The AJPH recognized our research paper as one of the journal’s winners of the 2017 Paper of the Year, for contributing, “to our knowledge and understanding of a significant public health issue.”https://ajph.aphapublications.org/doi/10.2105/AJPH.2017.304134

In announcing their decision, the AJPH judges stated the research “added to the population health road map by illustrating that there are many sectors, including private, that have levers to pull to positively influence population health.”

If other stakeholders joined us in exiting tobacco, it could have an even more profound public health impact.

Vaping, an Emerging and Growing Threat

Even as cigarette smoking has been on the decline, use of vaping products — introduced as alternatives to cigarette smoking and often marketed as a “safer” option by manufacturers — has been on the rise. This is concerning because there is increasing evidence that vaping poses serious health risks.https://www.reuters.com/article/us-health-vaping/vaping-impacts-blood-vessels-even-without-nicotine-idUSKCN1VA29Thttps://www.washingtonpost.com/health/2019/08/16/mystery-lung-illness-linked-vaping-health-officials-investigating-nearly-possible-cases/?noredirect=on

According to the 2018 National Youth Tobacco Survey, 3.6 million middle and high school students were e-cigarette users, a dramatic increase from the more than 1.5 million students the previous year.https://www.fda.gov/tobacco-products/youth-and-tobacco/youth-tobacco-use-results-national-youth-tobacco-survey This represents a 78 percent increase among high school students, and a 48 percent increase among middle school students.

What’s even more disturbing is that the risks of vaping may not be well known or understood. Each day, we are learning more about the potential adverse health effects that may be linked to vaping.https://www.nap.edu/resource/24952/012318ecigaretteConclusionsbyEvidence.pdf Findings from a Morning Consult survey, sponsored by CVS Health, show that nearly eight in 10 Americans consider tobacco to be very harmful to one’s health, while just over half – 52 percent – consider vaping very harmful to one’s health.

Ongoing, Expanded Focus Reducing All Tobacco Use

As a health care innovation company, and as a reflection of our purpose to help people on their path to better health, we do not sell vaping products at any CVS Pharmacy location. After years of decline in the youth smoking rate, today young adults who use e-cigarettes are four times more likely to begin smoking traditional cigarettes, according to the Truth Initiative.https://truthinitiative.org/research-resources That’s why, we are is expanding our focus to aggressively tackle this growing epidemic with new partnerships and funding.

We are expanding our focus to aggressively tackle the growing epidemic of youth vaping. 

Today, the Aetna Foundation is pledging an additional $2 million to provide educational materials and tools to prevent smoking and vaping to thousands of clinicians who are part of organizations such as the American Academy of Pediatrics, the National Medical Association and the National Association of School Nurses.

This builds on a $10 million commitment announced in June to combat vaping. As part of that effort, the CVS Health Foundation is partnering with Discovery Education and the CATCH Global Foundation, to create an educational curriculum on the dangers of vaping for middle school students that will be made available to every school district in the U.S. These resources will also be made available to parents at no cost. These anti-vaping initiatives build on the accomplishments of the Be The First program to date, including reaching nearly 13 million young people, helping more than 200 colleges and universities in their efforts to go tobacco free, and funding the first-ever vaping cessation program in partnership with the Truth Initiative.

As we look to 2020, we plan to expand our tobacco-cessation expertise, particularly within the Medicaid program where smoking rates are considerably higher than among all adults. More than a quarter (25.3) of all Medicaid enrollees smoke compared to 11.8 percent of people enrolled in private insurance, according to the Centers for Disease Control and Prevention.https://www.cdc.gov/mmwr/volumes/67/wr/mm6713a3.htm A recent study by University of California San Francisco also found that reducing smoking and its associated health effects among Medicaid recipients in each state by just 1 percent would save the Medicaid program an estimated $2.6 billion within one year.https://www.ucsf.edu/news/2019/04/413921/medicaid-could-save-26-billion-within-year-if-just-1-percent-recipients-quit

Ending tobacco sales and addressing the e-cigarette epidemic are just the beginning of our broader effort to transform the delivery of health care, one individual and one community at a time. By proactively addressing consumer health needs, we are building a transformative health care company that will engage consumers when and where they need care, help people achieve better health at a lower cost and help simplify a complicated health care system.

09.03.19