Put It Out Rockland

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Put It Out Rockland

• A successful smoking cessation program

Una Diffley, MPH Public Health Education
Coordinator Rockland County Department of
Health 845..364.2127 Diffleyu_at_co.rockland.ny.us
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Historical Perspective

• County receives share of M.S.A. money in
  2000(Master Settlement Agreement)
• Used MSA funds to develop a Comprehensive
  Tobacco, Prevention, Education and Cessation
  Program (based on Program and Funding Guidelines
  for Comprehensive Tobacco Control Programs
  developed by CDC and Preventions Office on
  Smoking and Health.)
• MSA money securitized in 2003
• County government pledges to maintain funding for
  tobacco programs

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Put It Out Rockland

• Goal
• To achieve an adult smoking rate of 12 by 2010
• Objective
• To provide direct cessation services and
  resources for residents of Rockland County, with
  special emphasis on households of undeserved
  populations.
• To provide nicotine replacement therapy to
  participants in smoking cessation programs, when
  appropriate

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Program Development

• 2 tobacco cessation specialists were hired
• Attended 5 day training at U Mass Medical School
  (Center for Tobacco Prevention and Control)
• Reviewed best practices
• The Put it Out Rockland Program was created and
  sponsored by the Rockland County Department of
  Health, which offered an 8 week behavior
  modification program and included free nicotine
  replacement therapy.

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Program Overview

• FACILITATOR GUIDE
• Session Outline and Full Script
• Explanation of Record Keeping and Evaluation
  Procedures
• New Facilitators Trained By Observing Program
  Staff
• PARTICPANT GUIDE
• Session Specific
• Group Activities and Educational Materials

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Integration for Success

• Nicotine Patch duration 8 weeks is effective
• Treatment efficacy using one clinician type
  increases success by 18.3 (PHS Guidelines, 2000)
• Combination of Behavior Modification Therapy and
  pharmacotherapy (NRT) is more effective than
  either one alone (Treatment Strategies U. Mass
  Medical School TTST Manual)

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AN ENHANCEMENT OF BEST PRACTICE

• Some smokers need longer course of treatment
• Duration tailored to meet individuals needs. (US
  Health Human Services 10/2000)
• Combination of pharmacotherapies Evidence
  suggests that combining the patch with either
  nicotine gum or lozenge increases long-term
  abstinence rates over those produced by a single
  form of NRT (US Dept Health Human Service PHS
  Guidelines, 2000)

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Nicotine Replacement Therapy

• Comprehensive Medical Eligibility Screening
  Procedure
• Nicotine Transdermal Patch, Nicotine Gum,
  Nicotine Lozenge
• Up to 10 weeks of NRT Provided Free to Medically
  Eligible Participants
• NRT Distributed Every Two Weeks

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Evaluation Methods and Highlights

• Continuous, Ongoing, and independent evaluation
• Pretest and post-test surveys
• 3, 6, and 12 month telephone follow-up
• Documentation of NRT usage
• Cessation rates calculated for program
  completers, and conservatively to include program
  dropouts
• Cessation rates calculated by NRT dosing schedule

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PIOR

• Over 3 years, over 869 smokers have participated
  in PIOR, with 624 (75) completing the program.

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Year One Quit Rates
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Tailoring Methodology

• Three methods
• Fagerstrom score
• Number of cigarettes smoked
• Weekly difficulty ratings
• Determine
• Duration of patch use
• Dosing of patches
• Offer of combination therapy

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Three years of PIOR Quit Rates
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Quit Rates by Type of NRT
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Quit Rates by Patch Duration
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Program Completion vs. Program Quit Rates

• In addition, data suggest that the program
  attracted heavy smokers who had never tried to
  quit before
• Smokers who smoked 35 or more cigarettes a day
  and/or who had never tried to quit were more
  likely than other smokers to drop out of the
  program in the early sessions
• However, the novice quitters who remained in
  the program were slightly more successful at
  quitting than other smokers at 6 months and 12
  months and
• Those heavier smokers who stayed in the program
  benefited from the NRT tailoring and enjoyed
  slightly greater success over the long term.

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Smoking Rates and Related Attitudes

• The strong PIOR evaluation data have been shared
  with the County legislature, reported in the
  local media, and presented in various community
  venues to assure continued funding and community
  support.
• Assure continued funding through PIOR
  participants writing letters to legislators

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PIOR Success Story

• Charlie, 80 years of age,
• Smoked 60 years
• Quit after his 2nd attempt
• A year after his last cigarette Charlie claims
  he feels better than he has in years.

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PIOR a work in progress

• Three years of data demonstrate that PIOR is a
  successful smoking cessation program.
• DOH is committed to expanding its reach to reduce
  disparities in smoking rates.
• Materials have been translated into Spanish and
  French.
• PIOR facilitators from these communities have
  been trained.

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Work in Progress

• The DOH has forged a relationship with ESL
  providers in the county to recruit non-English
  speaking smokers
• PIOR partnered with Steps to a Healthier NY in
  Rockland County in 2004 by incorporating Diabetes
  Risk Assessment into the program and referring
  participants to physicians and CDEs
• Also has a exercise and nutrition/weight loss
  component in curriculum.

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PUT IT OUT ROCKLAND AN AWARD WINNER!

• 2004 - The National Association Of County and
  City Health Officials (NACCHO) presents MODEL
  PRACTICE award to Put It Out Rockland.