Reflections & Resolutions

CINDY SANDERS

Reflections & Resolutions | Susan R. Cooper, tobacco, Non-Smokers Protection Act

A Conversation with Commissioner Susan Cooper

As we put the old year to rest and turn our attention to what promises to be a fiscally challenging 2009, Tennessee Department of Health Commissioner Susan R. Cooper, MSN, RN, took time to share with Memphis Medical News her reflections on current programming and resolutions for a healthier citizenry.

"We know four behavioral factors lead to chronic illness," Commissioner Cooper stated, listing tobacco use, physical inactivity, poor nutritional choices and alcohol abuse. Finding effective ways to address these behaviors has been her guiding passion since stepping into the role of chief public health official in 2007.

One of the biggest health risks, tobacco use, is also one of the hardest addictions to break. However, Tennessee has seen improvement in the wake of the Non-Smokers Protection Act, which went into effect October 1, 2007.

"We've had such a great success and a great reception from businesses across the state," Cooper said, adding that over the course of the first year less than 160 letters of warning were issued and only 13 of those resulted in fines.

The multi-pronged attack on tobacco use also included educational campaigns, increased training for smoking cessation counselors and seed grants to fund programs targeting adolescent smoking rates.

In the past year, Tennessee teens created public service campaigns that hit the mark with their peers. In Bradley County, Cooper said adolescents used pictures of animals smoking cigarettes with a tag line that read, 'It looks just as stupid when you do it.' Similarly, students at Oliver Springs High School in Roane County created a video campaign that depicts a teenage girl taking power over tobacco and her life.

"There are programs like this all across the state," Cooper said. "These kids are the leaders of our future … it's unbelievable the talent that exists."

In addition to increased awareness, Cooper said there has been increased activity at the county health department level. In 2008, Cooper said more than 250,000 Tennesseans were screened for tobacco use at their local health department. Approximately 32 percent used tobacco of some type. Of those who did use tobacco, nearly half were willing to give it up. Of those willing to quit, 13 percent took the next step and enrolled in one of the treatment protocols provided by the state.

"These are the folks most likely not to have the resources to purchase aids to help them quit," she said of Tennesseans utilizing local health department services. "Our preliminary numbers show we have about a 7 percent quit rate, which is consistent with the literature and research," she continued, noting that it often takes more than one attempt to break the addiction.

Despite past success, Cooper said she is concerned … particularly in these challenging economic times … that current smokers might put off New Year's resolutions to quit or former smokers might revert to tobacco use to relieve stress. Healthcare providers are encouraged to share the Tobacco Quit Line number… 1-800-QUIT-NOW… with patients to provide extra support at no charge.

Cooper added she is very pleased with the tobacco cessation infrastructure that is now in place across all 95 counties.

"Have we eliminated tobacco use in Tennessee? No, but we're making progress," she said, adding that Tennessee is the first tobacco-producing state to implement such broad cessation programming. "I really think we are a model for the country."

Consuming more energy than is burned is an equally detrimental behavior. To combat the problem, GetFitTN — www.getfitTN.com — was created as a fun, interactive site to get Tennesseans moving.

Visitors have the opportunity to access free tools and information to meet weight loss and activity goals, ask registered dieticians and qualified fitness experts questions online, and even get menu ideas. The new Get Fit cookbook features affordable meals that have been tested by Tennessee high school students to make sure they are both nutritious and delicious.

Cooper said the new nutrition tracker is a powerful weight loss resource. "We know that those who journal can lose up to 50 percent more weight than those who do not journal."

She noted individuals also have the ability to monitor and track their own fitness goals, as well as health indicators such as blood sugars, cholesterol and hemoglobin A1c. She added the site is HIPAA compliant and password protected.

The Web site also allows for team challenges and group fitness goals. "Small businesses can use it as a worksite wellness program," Cooper pointed out.

All of the online resources are available at no charge. "If we say we're committed, then we have a responsibility to put tools in the hands of those who live here to help them on their journey," she stressed.

Last year also found Tennessee the recipient of a number of national accolades including achieving "gold status" for the state's cancer registry, recognition for the state laboratory and a "perfect 10" for emergency preparedness.

Despite the accomplishments of 2008, Cooper is clearly concerned about the impact budget cuts will have on programming. The Department's proposed full budget for FY 2009/10 is nearly $555 million. However, a revised budget with a 3 percent reduction has already been crafted, and staffers are preparing for another version that could have as much as $21 million in cuts.

Cooper said she views everything on the table as fitting into three buckets: must dos, should dos, and nice to dos. The "must dos" encompass protecting the health of the public and include items such as monitoring outbreaks, performing epidemiologic surveys and conducting food safety inspections. The "should dos" include making continued inroads into changing risky health behaviors. Realistically, some of these programs might be scaled back or eliminated based on performance outcomes. The "nice to dos" are probably off the table in the current economic climate.

"What I'm asking people to do is to understand we will make the best decisions we know how to make within the fiscal constraints," she said. "The decisions we make will not be popular with everybody," she continued, adding that as commissioner she ultimately shoulders the accountability and responsibility for those decisions.

"We will continue to strive to deliver the best care possible in the most efficient way we know how," Cooper vowed. "We are firmly committed to protecting the public health, promoting health and improving health," she stressed, adding, "We've tried to put a meaningful infrastructure in place to handle times like these. When times get tough, you innovate … it's time to leverage some of those public/private partnerships."