Guest Author: Dr. Albee Budnitz
Two Decades of Support to Quit Tobacco from the NH Quitline
The New Hampshire (NH) Tobacco Prevention and Cessation Program is celebrating 20 years of the NH tobacco quitline through QuitNow-NH, offering cessation support to NH residents. These services were made possible when state attorneys general around the country joined forces to file a class action suit against big tobacco. They were awarded settlements, now referred to as the Master Settlement Fund, resulting in millions of dollars paid annually to states to fund proven prevention and treatment efforts – saving countless lives.
From Stigma to Support: How Tobacco Use Treatment Has Evolved
As a physician, I remember what it was like before QuitNow-NH, the state’s tobacco Quitline. Like so many behavioral health issues, we had little to offer to patients and largely left them to figure it out on their own. We falsely assumed quitting was largely about having an adequate amount of willpower instead of proven tactics or skill power. This fed the stigmatizing attitude about substance use disorder where we blame the individual rather than our environment.
Today we know this is not true and we’ve slowly adopted strategies that prevent and reduce harm. A catalyst for this shift in terms of patient engagement was the publication of the Public Health Service Clinical Practice Guideline on Treating Tobacco Use and Dependence in 2000 and the update in 2008. The clinical guidelines promoted the strong evidence that coaching, medication, and quitlines boost cessation rates. Then in 2014, the Affordable Care Act required insurance plans to cover tobacco treatment as an essential health benefit. This encouraged changes to medical records that reminded us to routinely ask, advise, and refer.
Looking Ahead: Addressing Emerging Challenges in Tobacco Use
As healthcare professionals, planners, and administrators, we have come so far in creating systems that identify and support patients in addressing challenging behaviors. Now we partner with patients – meet people where they are, first by screening them on their tobacco use, then engaging them in conversation about their needs, beliefs, and readiness to quit. We are able to offer tailored help, so they can choose the best approach to quitting whether it’s the use of the Quitline, medications, or something else. QuitNow-NH ensures all of our patients, regardless of insurance or zip code, can access culturally sensitive coaching and cessation medications where and when it works best for them.
This didn’t happen overnight. Countless advocates came together to ensure the monies from the Master Settlement Agreement were spent on prevention, treatment, and control. Let’s celebrate those achievements while also staying vigilant about new health challenges from the use of products like electronic cigarettes (e-cigs or vapes) and Zyn pouches. These challenges require us to be good stewards of the funds so our residents have the services in place when they need them over the next 20 years.

Dr. Albee Budnitz
Dr. Albee Budnitz is a board-certified healthcare professional with a longstanding commitment to holistic, patient-centered primary care to address the whole person including the social factors impacting their health. Over the years, Dr. Budnitz has been a passionate advocate, educator, and leader in the fight against tobacco-related diseases. His work spans local, regional, and national levels, including collaborations with organizations such as the Nashua Prevention Coalition, Breathe NH, NH Department of Health and Human Services, and national groups like the American College of Chest Physicians, National Association for Medical Direction of Respiratory Care, and American Thoracic Society. Retired now, Dr. Budnitz continues to combat tobacco use disorder.