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Advancing Cessation through Community Networks

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. Session Overview. Review recommended cessation strategies Apply examples of cessation strategies from Indiana

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Advancing Cessation through Community Networks

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  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@lutheran-hosp.com Secretary/Treasurer Smokefree Allen County

  7. The Making of a Comprehensive Community Cessation Program

  8. Dr. Kim Herlan, Cardiovascular Surgeon A Man With a Dream Youth Education Program Graphic Surgical Video Kicking Butts In the Summit City

  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 Indiana’s 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 Goals Strategies

  14. SFAC Organizational Chart

  15. www. white lies.com Allen County Residents Call SFAC ITPC Statewide Media Campaign CommunityCessation Classes Medical Community Lutheran Hospital Tobacco Intervention Program Area Hospitals Support Group

  16. Smokefree Allen County Group Classes

  17. Allen County:Three 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. 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

  26. Engaging Physicians in Tobacco Control • Be specific • Send ahead a fax with project info • Contact office manager • Provide materials—posters, patient education pieces, stickers, cards • Support physicians’ efforts-tell patients to ask their doctors for help

  27. Identify a Local Champion • Local hospital • Target certain specialties • County Medical Society or State Medical Association Alliance/Chapters

  28. Challenges • Getting physician attention • Convincing them that they can impact a patient’s care • Getting them to file claims-minimal reimbursement fees

  29. Indiana State Medical Association Adele M. Lash alash@ismanet.org 317.261.2060

  30. TobaccO User’s 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

  31. 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 Collaborators

  32. 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

  33. 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

  34. 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.

  35. 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

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

  37. 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

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

  39. 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

  40. 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 PI’s office with questions about program

  41. 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 Results-Students

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

  43. Project TOUCH Julie Nowak jnovak@nursing.purdue.edu 765.494.4004

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

  45. Indiana Tobacco Prevention and Cessation www.itpc.in.gov 317.234.1787

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