Investing tobacco settlement monies to expand physician care

Aloha. This year, the John A. Burns School of Medicine is asking the Hawai’i State Legislature to extend the sunset date on tobacco master settlement agreement monies for continued use by the school until 2015.

Monies from the tobacco settlement are helping us reach out to the Islands of Hawai’i in unprecedented ways. Third-year medical students now have the option of training in Hilo, West Hawai‘i, Maui and Kaua‘i. First-year and fourth-year medical students have the opportunity for elective rotations on the islands of Hawai‘i, Maui, Kaua‘i and Moloka‘i. And, in January 2011, for the first time, first-year medical students have been placed in Hilo for a required three-month training block. We continue to work to develop programs to train medical students in their first years of practice on the neighbor islands, where a statewide shortage of physicians is most acute.

Monies from the tobacco settlement fund also enable JABSOM to continue programs to train speech pathologists, medical technicians, and public health specialists. JABSOM is the only avenue of training in these fields in Hawai‘i. In addition, much of the workforce needed to treat the effects of tobacco use and to develop and implement programs for tobacco cessation are from JABSOM and its Office of Public Health Studies.

The John A. Burns School of Medicine’s faculty, students and staff work diligently on the front lines of community centers trying to mitigate smoking’s deadly impact. Half of all physicians practicing in Hawai‘i and treating Hawai‘i’s people right now are either JABSOM faculty members or graduates of JABSOM or its post-graduate residency training programs.

Research studies, including one study released in December 2010, continue to show the health risks associated with tobacco use, including some of the most troubling harm to tobacco’s innocent victims: our youngest keiki. It is estimated that 60 percent of American children ages 4–11 years are exposed to secondhand smoke at home. Research has shown that children(especially infants) of parents who smoke have more lung illnesses, such as bronchitis and pneumonia, and can develop asthma. Most recently, scientists reported that keiki even suffer higher blood pressure from exposure to second-hand smoke.

For the children, our Pediatrics Department supports a tobacco cessation program. JABSOM supports the Principal Investigator and 95% of the Director’s time to oversee the Healthy Quit Smoking Program at the Kapio‘lani Medical Center for Women and Children. This service,which has trained and coordinated the services of 170 certified tobacco cessation specialists, nurses, and other health officials, seeks to reduce smoke exposure in the home (and car) affecting our children. This past year, the program received 2,210 referrals. Many of those were women, from low incomes, and about half were of Native Hawaiian ancestry.

The program works. After six months of counseling, the number of women smoking in the home was reduced from 18% (nearly one in five participants) to only 5%. At the start, just over half of the participants smoked in their car. That percentage was slashed by almost 40%. Funding comes from the Tobacco Prevention & Control Trust Fund and the Hawai‘i Community Foundation, but also from the JABSOM’s significant contribution of the time and salary of thePrincipal Investigator (100%) and the Director (95%). Further, our Perinatal Addictions Treatment Clinic (PATH) Clinic, initiated with help from the Women’s Caucus of the Hawai’i State Legislature, provides OB/GYN treatment and counseling for pregnant women and new mothers who are struggling with addictions, including smoking. Founded by one of our JABSOM faculty and staffed by the medical school’s practice plan, this year the clinic began offering education in early childhood development, which includes the particular harms that addicting substances can cause for children.

Our medical students continue to voluntarily treat Hawaii’s homeless families (primarily children) at four state-sponsored shelters twice per week. Such efforts include an emphasis on healthy life-styles, including tobacco cessation. Also, our faculty and students are actively involved in a variety of programs that benefit Kindergarten through 12th grade. Medical students visit 4th and 5th graders at schools throughout O‘ahu, to provide interactive educational sessions about the risks, dangers and societal costs of tobacco smoking. The counseling is especially effective at securing the attention of pupils, because our medical students are closer to their own ages than many traditional role models.

Our medical school provides services at community health centers, including those in Kalihi-Pālama, Waimānalo, on the North Shore of O‘ahu, and Waikīkī, where patients are treated for tobacco-related illness and offered advice and help about reducing or stopping tobacco intake. Five to six first-year medical students are deployed to regional centers to work with patients each year. Tobacco cessation and tobacco dependence treatment for the people of Hawai‘i are prominent throughout the medical school’s curriculum. Our faculty, residents, medical students and related health care professionals provide care daily in offices, clinics and hospitals throughout Hawai‘i. These healthcare providers routinely offer smokers help to quit smoking through interventional counseling.

The medical school’s Cardiovascular Research Center has begun a partnership with The Queen’s Medical Center to train two fellows (specialists) per year in cardiovascular disease, to help redress the lack of cardiologists in Hawai‘i and to serve victims ofcardiovascular disease. Smoking is a significant contributor to such cardiovascular disease, including strokes and heart attacks. Research in the Center for Cardiovascular Research will also focus on the impact that the abuse of methamphetamine and other drugs have on the heart.

Please note that the direct application of tobacco settlement funds to the programs cited above is not always readily apparent in the University accounting system, since the funds are received very late in the fiscal year (due to mainland protocols in administering the monies from the fund). JABSOM thus must use funds from other sources to cover these vital services until the tobacco funds arrive at the end of the fiscal year. Nonetheless, these funds are essential to the operations of the school and its ability to meet its missions to the community. We are proud to express our appreciation for this funding from the Hawai‘i State Legislature and former Governor Ben Cayetano. The school makes a daily commitment to better health and overcoming and addressing the ills of tobacco use, which will continue to challenge our state for generations to come.

To commemorate the importance of these funds, the medical school has installed signs on campus emphasizing that Tobacco Master Settlement Agreement funding has contributed to the construction of the medical campus buildings  Related information is provided to our students and visitors during tours and training orientations. During our public tours of the campus and facilities, community groups and visitors learn how tobacco-related illness hurts our populations by increasing organ injury and raising costs for care and treatment. (Health care costs in Hawai‘i related to tobacco use are estimated to exceed $350 million annually in Hawai‘i.)

Our medical students organize and host an annual community health fair on campus, drawing media coverage and hundreds of citizens to see health products from local vendors and to learn about health care issues through health exhibits. Counseling against tobacco use is a primary focus of the health fair, with active participation by the Coalition for a Tobacco Free Hawai‘i and other partners. Our Director of the Office of Public Health Studies at the medical school writes the questionnaire, analyzes the data and writes the reports evaluating the statewide Clear The Smoke and Quitline campaigns.

We have a number of integrated programs aimed at cancer care and prevention throughout the Pacific. The “CEED” program is one that helps spread better health and prevention throughout the U.S. Affiliated Pacific Islands, as well as, among Pacific Islanders in Hawai’i. The Hawai‘i Consortium for Continuing Medical Education provides required continuing  education for physicians, frequently including updates and briefings about tobacco-related illness. The sponsorship committee consists of representatives of the Hawai‘i Medical Association and the John A. Burns School of Medicine. The education efforts contribute to the significant role in tobacco cessation played by primary care physicians. From 1999 through last year, some 25 sessions by the school’s Department of Medicine alone focused on tobacco cessation.

In addition to supporting our tobacco cessation efforts, the tobacco settlement monies are an INVESTMENT by the Legislature, which has directly contributed to our school’s ability to grow more physicians (who in turn care for more of those affected by tobacco-related illness). These funds helped mitigate the more than $6 million dollar reduction in our annual state general funding appropriations over the last few years. Additionally, these funds assist in supporting the cost of JABSOM’s recent efforts to increase the incoming medical student class size from 62 to 64 students. This increase, which we hope to be able to build upon with future class size expansions, requires commitment from our faculty, staff and administrators. We simply are not able to consider increased enrollment to meet workforce needs statewide without continued financial support from the Legislature. 

The significant shortage of physicians in Hawai‘i worsens annually as the population ages and requires more care. The John A. Burns School of Medicine is the best source for doctors in our community. We train 256 medical students year-round, and, through partnering with our major local hospitals, we simultaneously train another 240 post-graduate trainees or “residents”: men and women with their medical degrees who are treating patients while mastering their skills in fields including internal medicine, pediatrics, obstetrics and family medicine. We have another 12 students who are from culturally disadvantaged backgrounds for whom we are providing a fifth year of college study, so that they may become medical students. Additionally, we have another approximately 120 undergraduate students studying health sciences, including Public Health, Medical Technology and Communication Science Disorders.

JABSOM attracts major funding into the community – $70 million awarded last year — that supports jobs in Hawai‘i, providing research and outreach to benefit our community. In directing JABSOM to use tobacco settlement monies for some of our operating expenses, the Legislature has allowed the medical school to survive. JABSOM is able to lead through the provision of comprehensive services related to tobacco cessation, including prevention, outreach, education and treatment, while training needed health care professionals for the future throughout Hawai‘i. We hope you will join us in conveying the message that tobacco master settlement monies are well spent at the University of Hawai’i’s medical school, to help to improve the health care of Hawai’i’s citizens every day: now and in the future, for every community in our State.

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