[Federal Register Volume 88, Number 125 (Friday, June 30, 2023)]
[Notices]
[Pages 42377-42379]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-13928]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES


Request for Information: Draft HHS 2023 Framework To Support and 
Accelerate Smoking Cessation

AGENCY: Office of the Assistant Secretary for Health (OASH), Office of 
the Secretary, Department of Health and Human Services (HHS).

ACTION: Notice of request for information.

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SUMMARY: The Department of Health and Human Services (HHS or 
Department) is issuing this request for information (RFI) to receive 
input from the public on the Draft HHS 2023 Framework to Support and 
Accelerate Smoking Cessation to guide the Department's efforts to 
sustain and strengthen existing programs and drive further progress 
toward smoking cessation, with an emphasis on serving populations and 
communities disproportionately impacted by smoking-related morbidity 
and mortality.

DATES: To be assured consideration, comments must be received at the 
email address provided below, no later than midnight Eastern Time (ET) 
on July 30, 2023. HHS will not reply individually to responders but 
will consider all comments submitted by the deadline. Please do not 
provide confidential information as comments may be published or 
otherwise used for agency purposes.

ADDRESSES: Please submit all comments via email to 
[email protected] as a Word document, Portable 
Document Format (PDF), or in the body of an email. Please include 
``Request for Information: Draft HHS 2023 Framework to Support and 
Accelerate Smoking Cessation'' in the subject line of the email 
message.

FOR FURTHER INFORMATION CONTACT: Please submit questions for further 
information to Sarah Boateng, Principal Deputy Assistant Secretary for 
Health. Email: [email protected] at (202) 205-0725.

SUPPLEMENTARY INFORMATION: The mission of HHS is to enhance the health 
and well-being of all Americans, by providing for effective health and 
human services and by fostering sound, sustained advances in the 
sciences underlying medicine, public health, and social services.
    On February 22, 2022, President Joe Biden and First Lady Jill Biden 
reignited the Cancer Moonshot, setting an ambitious, achievable goal: 
to reduce the death rate from cancer by at least 50 percent over the 
next 25 years and improve the experience of people and families living 
with and surviving cancer, ultimately ending cancer as we know it. 
Additionally, on January 20, 2021, President Biden signed Executive 
Order 13985, Advancing Racial Equity and Support for Underserved 
Communities Through the Federal Government, which directed the 
Department to make achieving health equity part of its mission by 
developing programs, policies, and activities to address the 
disproportionately high and adverse health disparities in underserved 
communities. Then on February 16, 2023, President Biden signed 
Executive Order 14091, Further Advancing Racial Equity and Support for 
Underserved Communities Through the Federal Government. This second 
Executive Order reaffirmed the Administration's commitment to health 
equity by extending and strengthening equity-advancing requirements for 
agencies.
    To support the executive order initiatives, and to pursue the 
Administration's priorities for advancing health equity and driving 
down cancer deaths, the Office of the Assistant Secretary for Health 
(OASH) is leading the development of a framework to support and 
accelerate smoking cessation. The Draft HHS 2023 Framework to Support 
and Accelerate Smoking Cessation (the Framework) will provide direction 
to enhance collaboration and coordination across HHS, and with Federal 
and non-Federal stakeholders, drive further progress toward smoking 
cessation and delivering equitable outcomes for all persons in America. 
The draft Framework was developed with valued input from subject matter 
experts across HHS Operating Divisions. The Framework aims to 
accelerate smoking cessation and reduce smoking-related health 
disparities by building on current activities and collaborations across 
the Department, including work guided by the HHS Tobacco Control 
Strategic Action Plan developed in 2010.
    The scope is focused on cessation of the use of commercial 
cigarettes, cigars, and cigarillos, for people of all ages across the 
lifespan. The Department also recognizes the importance of tobacco use 
prevention and cessation of other tobacco products. These issues as 
well as those related to e-cigarettes are topics that are out of scope 
for this phase but will be addressed in a later phase of this effort.
    The purpose of this request for information (RFI) is to seek public 
comment on the Draft 2023 Framework to Support and Accelerate Smoking 
Cessation. Please see the Draft Framework below, followed by an RFI in 
the form of questions to the public.

Draft U.S. Department of Health and Human Services 2023 Framework To 
Support and Accelerate Smoking Cessation

Background

    Cigarette smoking is the leading cause of preventable disease, 
disability, and death in the United States, including about 30% of all 
cancer deaths. Enormous progress has been made over the last 60 years 
in driving down rates of cigarette smoking. In 2021, 11.5% of U.S. 
adults smoked cigarettes, down from an all-time high of 42%, and two-
thirds (66.5%) of all adults who ever smoked cigarettes have quit. 
Despite this progress, cigarette smoking still claims approximately 
480,000 American lives every year.
    Furthermore, the gains that have been made over the past several 
decades have not occurred equally across the population, leaving behind 
many of those who have the least resources and who face the greatest 
barriers to quitting. Encouraging and assisting every person in America 
to quit smoking is critical to ensuring a healthier future for all 
people in America and to helping achieve the Cancer Moonshot goal of 
reducing cancer death rates by at least half over

[[Page 42378]]

the next 25 years, a central part of President Biden's Unity Agenda, 
issues areas where all of us can come together and make additional 
progress for the American people. In fact, ahead of the President's 
State of the Union, the Administration announced that helping Americans 
avoid smoking in the first place and supporting Americans who want to 
quit would be a major priority for the President's Cancer Moonshot this 
year.

Vision

    The Framework vision is to ensure that every person in America has 
access to comprehensive, evidence-based cessation treatment and can 
benefit from HHS cessation supports, programs, and policies.

Framework Goals

    The Framework is organized around the six goals that serve as a 
foundation for long-standing HHS efforts to support and promote 
cessation. Moving forward, these goals will guide future HHS cessation 
actions, building on the work that is already underway to achieve the 
Framework vision.
    The Framework identifies six goals.

1. Eliminate smoking- and cessation-related disparities
2. Increase awareness and knowledge related to smoking and cessation
3. Strengthen and sustain cessation services and supports
4. Increase access to and coverage of comprehensive, evidence-based 
cessation treatment
5. Expand surveillance of smoking and cessation behaviors and 
strengthen performance measurement and evaluation
6. Promote ongoing and innovative research to support and accelerate 
smoking cessation

Cross-Cutting Principles

    The Framework is underpinned by cross-cutting guiding principles 
that apply across all six goals. These cross-cutting principles reflect 
the Department's commitment to leveraging the best available smoking 
cessation science, programs, and policies to reach diverse populations 
and all communities across America.

 Advancing Equity: Employ culturallycompetent strategies that 
support and accelerate cessation, focusing especially on groups with 
high smoking prevalence and/or persistent cessation-related disparities
 Community Engagement: Ensure that the public, especially 
communities that are disproportionately affected by smoking, are 
engaged in the development and implementation of cessation programs, 
policies, and infrastructure
 Coordination, Collaboration, and Integration: Promote 
coordination, collaboration, and integration of programs and activities 
across HHS to support the implementation and sustainability of 
effective cessation practices, programs, and policies
 Evidence-Based Approaches: Leverage the strongest evidence 
base to guide actions for cessation treatment and messaging, while 
identifying research gaps and needs

Broad Strategies

    Each of the six goals are supported by broad strategies to drive 
progress toward smoking cessation at the population and individual 
levels. HHS will advance the Framework goals through coordinated 
strategies that leverage the full capacity and resources of the 
Department, including continued support for ongoing activities that 
serve these goals.

Goal 1: Eliminate Smoking- and Cessation-Related Disparities

    Addressing disparities in smoking prevalence rates and cessation 
outcomes is essential to achieving equitable progress in reducing 
smoking-related morbidity and mortality. A commitment to health equity 
involves understanding health disparities related to smoking and the 
factors that cause these disparities. Through the Framework, HHS seeks 
to execute broad strategies that will reach all communities and address 
unique barriers to cessation experienced by disparately affected 
groups.
    Examples of broad strategies that advance this goal include:

 Promoting access to cessation resources that are culturally 
competent and use consumers' preferred languages
 Engaging community partners in promotion and outreach to key 
population groups, focusing especially on groups with high smoking 
prevalence and/or persistent cessation-related disparities
 Building capacity for cessation services and supports in care 
settings serving key populations
 Regulating the manufacturing, marketing, and distribution of 
tobacco products to protect public health

Goal 2: Increase Awareness and Knowledge Related to Smoking and 
Cessation

    Raising knowledge and awareness about the harmful effects of 
smoking and evidence-based cessation interventions drives attempts to 
quit and promotes treatment utilization. Through the Framework, HHS 
seeks to execute broad strategies that will increase awareness and 
knowledge related to smoking and cessation.
    Examples of broad strategies that advance this goal include:

 Expanding public education campaigns to increase knowledge 
about the harms of smoking and the availability of cessation services
 Coordinating with Federal and non-Federal entities to share 
cessation communication and education resources in order to amplify 
their reach
 Promoting covered cessation treatments to insurance 
beneficiaries and their health care providers

Goal 3: Strengthen and Sustain Cessation Services and Supports

    To help people quit smoking, it is important to have strong 
cessation supports in place with sustainable capacity and 
infrastructure. Through the Framework, HHS seeks to execute broad 
strategies that will support implementation of services that are 
evidence-based, optimally effective, engaging, and sustainable.
    Examples of broad strategies that advance this goal include:

 Strengthening and sustaining State and local cessation 
programs and activities
 Working to ensure a baseline level of service for State 
tobacco Quitlines
 Promoting connectivity and interoperability among HHS programs 
and partnerships with other Federal and non-Federal entities

Goal 4: Increase Access to and Coverage of Comprehensive High-Quality 
Cessation Treatment

    Ensuring that high-quality, comprehensive cessation support is 
accessible and affordable for all people in America is essential for 
advancing smoking cessation. The Framework seeks to execute broad 
strategies that will increase access to cessation treatment, especially 
in settings serving population groups that experience barriers to 
cessation and cessation-related disparities.
    Examples of broad strategies that advance this goal include:

 Working with health insurers, payers, States, health care 
facilities, community providers, and other stakeholders to remove 
coverage barriers to treatment
 Ensuring that smoking assessment and treatment delivery and 
referral are integrated into healthcare systems and connected to care 
for other health conditions

[[Page 42379]]

 Supporting, reimbursing, and evaluating innovative healthcare 
delivery methods that support cessation and provide long-term support 
to prevent and address relapse
 Promoting patient-centered approaches and ensuring that 
cessation protocols are evidence-based

Goal 5: Expand Surveillance of Smoking and Cessation Behaviors and 
Strengthen Performance Measurement and Evaluation

    Expanding capacity for surveillance and evaluation is critical for 
measuring progress, understanding barriers to quitting success, and 
rewarding effective service delivery. Through the Framework, HHS seeks 
to execute strategies that will support the measurement, monitoring, 
and tracking of patterns, trends, and progress.
    Examples of broad strategies that advance this goal include:

 Ensuring that surveillance systems can capture cessation-
related disparities and diverse tobacco use patterns
 Promoting development and use of common data elements
 Supporting program evaluation to ensure that high quality 
smoking cessation and related services are provided

Goal 6: Promote Ongoing and Innovative Research To Support and 
Accelerate Smoking Cessation

    A robust evidence base exists to inform smoking cessation programs, 
policies, and treatments. At the same time, it is essential to identify 
what gaps exist in our current understanding of what works to 
effectively address smoking cessation. Through the Framework, HHS seeks 
to execute broad strategies that will support research efforts to 
continually build the evidence base in this area.
    Examples of broad strategies that advance this goal include:

 Increasing understanding of how to optimize current smoking 
cessation interventions to maximize reach and treatment engagement and 
effectiveness, particularly among populations disparately impacted by 
smoking
 Supporting research on new cessation interventions
 Promoting sharing of data and resources generated by 
federally-funded research
 Identifying research gaps
    HHS is requesting information from the public regarding five 
questions.
    1. Are the proposed goals appropriate and relevant for addressing 
the needs of populations disparately affected by smoking?
    2. Do the broad strategies capture the key components and aspects 
needed to drive progress toward increasing cessation?
    3. Are there additional goals or broad strategies that should be 
included in the Framework?
    4. What targeted actions should HHS (Department-wide or within a 
specific HHS agency) take to advance these goals and strategies?
    5. What metrics and benchmarks should be included to ensure that 
the Framework drives progress?
    HHS invites all potentially interested parties--individuals, 
associations, governmental and non-governmental organizations, academic 
institutions, and private sector entities--to respond. HHS is 
interested in the questions listed above, but respondents are welcome 
to address as many or as few as they choose and may provide additional 
relevant information that is within the scope of the Framework. To 
facilitate review of the responses, please reference the question 
number in your response.
    This RFI is for planning purposes only and should not be construed 
as a policy, solicitation for applications, or as an obligation on the 
part of HHS to provide support for any ideas in response to it. HHS 
will use the information submitted in response to this RFI at its 
discretion and will not provide comments to any respondent's 
submission. However, responses to this RFI may be reflected in future 
initiatives, solicitations, or policies. Respondents are advised that 
HHS is under no obligation to acknowledge receipt of the information 
received or provide feedback to respondents with respect to any 
information submitted.

Sarah N. Boateng,
Principal Deputy Assistant Secretary for Health, Office of the 
Assistant Secretary for Health.
[FR Doc. 2023-13928 Filed 6-29-23; 8:45 am]
BILLING CODE 4150-28-P