Advancing Cessation through Community Networks

1
Advancing Cessation through Community Networks

• Anita W. Gaillard, M.S.P.H.
• Kathleen Jones, R.R.T.
• Adele Lash, B.S.
• Julie C. Novak, DNSc, RN, MA, CPNP

2
Session Overview

• Review recommended cessation strategies
• Apply examples of cessation strategies from
  Indiana
• Local coalition implementing a community-wide
  system approach.
• State medical association promoting provider
  education and reminder system.
• Pilot quit line and NRT for students, faculty and
  staff of college campus.

3
Guide to Community Preventive Services

• Evidence-based information on
• prevent tobacco product use initiation,
• increase cessation,
• reduce exposure to secondhand smoke.

4
Strategies to Increase Cessation

• Increasing price of tobacco
• Mass media education
• Smoking bans and restrictions
• Interventions appropriate for health care systems

5
Examples of Strategies

• Local coalition implementing a community-wide
  system approach.
• State medical association promoting provider
  education and reminder system.
• Pilot quit line and NRT for students, faculty and
  staff of college campus.

6
Kathleen Jones, RRT, CHt

• Coordinator,
• Nicotine Dependence Program
• Lutheran Hospital of Indiana
• Ft. Wayne, Indiana
• kjones_at_lutheran-hosp.com
• Secretary/Treasurer Smokefree Allen County

7

The Making of a Comprehensive
Community Cessation Program
8
Kicking Butts In the Summit City

• Dr. Kim Herlan,
• Cardiovascular Surgeon
• A Man With a Dream
• Youth Education Program
• Graphic Surgical Video

9
Past Community Cessation Efforts

• Lutheran, St. Joe, Parkview Hospitals
• Medical Groups
• No Set Schedule- scattered efforts
• Classes held when enough people registered
• ACS-Fresh Start
• ALA-Freedom From Smoking
• Potpourri used by some

10

• Coalition History
• 10 year old coalition was funded by the National
  Cancer Institute and the Center for Disease
  Control (CDC)
• Part of Project ASSIST
• Biggest Success Advocating and partnering with
  Ft. Wayne City Council to pass Indianas first
  smokefree restaurant and workplace ban.

11
Comprehensive Community Plan

• Public Forum
• Twelve Organizations
• Minority and Disparate Groups
• Dr. Herlan
• Ft. Wayne Health Commissioner
• Beginning of a Plan

12
ITPC Grant Workshop

• Multiple members attended
• We came back and developed four focus groups
• Prevention among youth
• ETS
• Adult cessation
• Identifying and eliminating disparities among
  minority populations
• All efforts were geared to the National
  Tobacco Control Framework by the CDC.

13
Center for Disease Control
National Tobacco Control Program Framework
Prevent Youth Initiation Promote Adult cessation Eliminate Exposure to ETS Identify Eliminate Disparities
Community Interventions
Counter Marketing
Policy Legislation
Surveillance Evaluation
Goals
Strategies
14
SFAC Organizational Chart
15
www. white lies.com
Allen County Residents
Call SFAC
ITPC Statewide Media Campaign
Community Cessation Classes
Medical Community
Lutheran Hospital
Tobacco
Intervention
Program
Area Hospitals
Support Group
16
Smokefree Allen County Group Classes
17
Allen CountyThree Service Levels

• Freedom From Smoking Group sessions, talk
  therapy
• Meets 4 times for 1 1/2 hours
• Step-by-step action plan to quit
• Accessible with multiple locations
• Access to bi-lingual support
• Tobacco Intervention Program
• Physician-directed pharmacotherapy
• Support Groups

18
Changing Hospital Culture

• Developed inpatient and outpatient counseling
  services
• Tobacco User Identification System
• Partnered With Nursing and Informatics services
• Hospital received and matched mini-grant
• Partnered With ER Staff
• Developed internal and external marketing tools

19
Tobacco Intervention Program

• TIP Components
• Team Approach
• Physician directed
• One-on-one intensive counseling
• Pharmacological treatment
• Behavioral treatment
• Hypnosis as adjunct to behavior change
• Relapse prevention
• Long term follow-up
• Keeps family physician in the loop

20
Insights

• Need a visionary/champion
• Must have a doer to implement the vision
• Need to be part of a community coalition with a
  comprehensive plan
• Must be relationship driven

21
Tobacco Cessation Education Project

Adele M. Lash, Communication Director, Indiana
State Medical Association
22
Helping Providers

• Hoosier adult smokers are 2.5 times more likely
  to quit smoking if a physician talks to them
  about their smoking.

23
Goal

• By 2004, increase by 5 physicians who provide
  tobacco cessation counseling

24
Resources to Help Physicians

• Training
• Mededcme.org
• Newsletter
• Information Cards
• Provider Reminder Systems
• Chart stickers

25
(No Transcript)
26
(No Transcript)
27
(No Transcript)
28
(No Transcript)
29
Provider Reminder Systems

• Prompts to health care providers
• Identify patient tobacco use status
• Discuss tobacco use cessation
• Applied to many settings and populations
• Prompts for other preventive services
• Barrier of setting up infrastructure

30
Engaging Physicians in Tobacco Control

• Be specific
• Send ahead a fax with project info
• Contact office manager
• Provide materialsposters,
• patient education pieces, stickers, cards
• Support physicians efforts-tell patients to ask
  their doctors for help

31
Identify a Local Champion

• Local hospital
• Target certain specialties
• County Medical Society or State Medical
  Association Alliance/Chapters

32
Challenges

• Getting physician attention
• Convincing them that they can impact a patients
  care
• Getting them to file claims-minimal
  reimbursement fees

33
Indiana State Medical Association

Adele M. Lash alash_at_ismanet.org 317.261.2060
34
TobaccO Users Cessation Helpline (TOUCH)

• Julie Cowan Novak DNSc, RN, MA, CPNP
• Professor/Head Purdue University School of
  Nursing
• Associate Dean, Pharmacy, Nursing and Health
  Sciences
• PNP, Purdue Family Health Clinic of Carroll
  County

35
Collaborators

• Purdue School of Nursing Counselors
• Angie Brown, MS, RN, CFNP
• Noelle Lottes, MS, RN, CFNP
• Julie Novak, DNSc
• Purdue University Student Health

• Purdue University Pharmacy
• Purdue University Residence Halls
• American Lung Association
• -Training and materials

36
Funding/Support

• Indiana Tobacco Prevention and Cessation Trust
  Fund
• American Lung Association (training)
• Purdue University
• School of Nursing
• Purdue University Student Health
• Purdue Residence Halls

37
Prevalence

• Purdue residence halls adopted a smoke-free
  policy in 2001
• Need for student cessation
• In 2001, 36 of Purdue students smoked or used
  other tobacco products
• National college-age average of 29
• In 2003, approximately 25 of Purdue students
  using tobacco products

38
Specific Aims/Goals

• Reduce tobacco use rates among students at
  Purdue.
• Change campus culture of tobacco use acceptance.
• Provide new knowledge regarding effective tobacco
  use cessation interventions for college students.

39
Target Population

• Phase I Purdue students initiated in 2002
• Phase II Purdue faculty and staff initiated in
  2003
• Phase III Purdue Family Health Clinic of Carroll
  County projected initiation in 2004

40
Methodology

• Callers to TOUCH helpline
• meet inclusion criteria
• ready to set a quit date within seven days
• randomized into two groups

41
Methodology

• Group 1 receives multiple telephone counseling,
  and
• Group 2 receives multiple telephone counseling
  plus nicotine replacement therapy.
• Group 2 subjects receive a health screening at
  Purdue University Student Health or in Nursing
  Center for Family Health

42
Methodology

• The telephone counseling provides information,
  advice, encouragement, and support through
  development of a personal action plan, coping
  strategies, and methods of obtaining support.

43
Methodology

• Education for change in campus culture
• articles in campus media
• ads/articles in student newspaper
• focus groups
• presentations in dorms, fraternities, and
  sororities
• fliers and wallet cards with contact information
• radio programs

44
Results-Students

• For 30 research participants in project
• 50 have been successful in maintaining their
  quit status for 3-9 months.
• 96 additional calls students not ready to set a
  quit date.
• 184 calls after hours (2-5 PM and 7-10 p.m.
  Monday Thursday)
• 55 student calls during day to PIs office with
  questions about program

45
Results-Students

• Difficult situations identified by male callers
• stress
• peer pressure/social situations

• Difficult situations identified by female
  callers
• stress
• weight gain/weight loss
• peer pressure/social situations

46
Results-Faculty/Staff

• Focus groups were held prior to the initiation of
  Phase 2 (Faculty/Staff)
• 56 Faculty/Staff calls to the helpline or PIs
  office
• 12 began counseling services with a majority in
  pre-contemplation or contemplation phase

47
Project TOUCH

• Julie Nowak
• jnovak_at_nursing.purdue.edu
• 765.494.4004

48
Training of Partners

• Next level of cessation-shifting focus from
  individual to community
• Policy changes drive cessation
• Multi-component programs
• Community wide cessation networks

49
Indiana Tobacco Prevention and Cessation

• www.itpc.in.gov
• 317.234.1787