Transcript Advancing Cessation through Community Networks Anita W. Gaillard, M.S.P.H.

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
– 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.
Guide to Community
Preventive Services
Evidence-based
information on:
•
prevent tobacco product
use initiation,
•
increase cessation,
•
reduce exposure to
secondhand smoke.
Strategies to Increase Cessation
• Increasing price of tobacco
• Mass media education
• Smoking bans and restrictions
• Interventions appropriate for
health care systems
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.
Kathleen Jones, RRT, CHt
Coordinator,
Nicotine Dependence Program
Lutheran Hospital of Indiana
Ft. Wayne, Indiana
[email protected]
Secretary/Treasurer Smokefree
Allen County
The Making of a Comprehensive
Community Cessation Program
Kicking Butts In the Summit
City
Dr. Kim Herlan,
Cardiovascular Surgeon
A Man With a Dream
Youth Education Program
Graphic Surgical Video
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
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.
Comprehensive Community
Plan
• Public Forum:
– Twelve Organizations
– Minority and Disparate Groups
– Dr. Herlan
– Ft. Wayne Health Commissioner
• Beginning of a “Plan”
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.
Center for Disease Control
National Tobacco Control Program Framework
Goals
Strategies
Community
Interventions
Counter
Marketing
Policy
Legislation
Surveillance
Evaluation
Prevent
Youth
Initiation
Promote
Adult
cessation
Eliminate
Exposure
to ETS
Identify
Eliminate
Disparities
SFAC Organizational Chart
Youth Committee
Cessation Committee
Second-Hand Smoke
Committee
Proprity Population
Partnerships
S.W.A.T Teams
3 County Schools
Benito Juarez Center
Minority Hlth.Coalition
Several Community
Cessation Sites & Support Groups
Train Facilitators
TIP - Pharmacologic Support
Help Union at GM to go SF
SF Dining Guide for County
Work Toward Expanding
Ordinance to County
Collaborate with Benito Juarez,
Minority Hlth.Coalition
Culterally Appropriate Awareness,
Leadership & Empowerment
Youth Leadership
Youth Empowerment
Encourage Medical Community
to Identify Tobacco Users
Advocate HMO Coverage
for Cessation
Promote Smokefree Policies
Training on Culturally
Appropriate Cessation
Prevention/Cessation
Programs
www.
white
lies.com
Allen County Residents
Call SFAC
ITPC Statewide
Media Campaign
Medical Community
Lutheran Hospital
Tobacco
Intervention
Program
Support Group
Community
Cessation Classes
Area Hospitals
Smokefree Allen County
Group Classes
Freedom From Smoking Sites
ASK Clinic
Benito Juarez Center
Family Practice Center
Indiana Purdue @ FW
Lutheran Hospital
Matthew 25
Neighborhood Health Clinic
Parkview Hospital
Shelter Outreach
St. Joseph Hospital
Worksites
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
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
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
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
Tobacco Cessation
Education Project
Adele M. Lash, Communication Director,
Indiana State Medical Association
Helping Providers
• Hoosier adult smokers are 2.5 times
more likely to quit smoking if a physician
talks to them about their smoking.
Goal
By 2004, increase by 5%
physicians who provide tobacco
cessation counseling
Resources to Help Physicians
• Training
– Mededcme.org
• Newsletter
• Information Cards
• Provider Reminder Systems
– Chart stickers
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
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
Identify a Local Champion
• Local hospital
• Target certain specialties
• County Medical Society or State
Medical Association Alliance/Chapters
Challenges
• Getting physician attention
• Convincing them that they can impact a
patient’s care
• Getting them to file claims-minimal
reimbursement fees
Indiana State Medical
Association
Adele M. Lash
[email protected]
317.261.2060
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
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
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
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
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.
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
Methodology
• Callers to TOUCH helpline
– meet inclusion criteria
– ready to set a quit date within
seven days
– randomized into two groups
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
Methodology
• The telephone counseling provides
information, advice, encouragement,
and support through development of a
personal action plan, coping
strategies, and methods of obtaining
support.
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
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
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
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
Project TOUCH
Julie Nowak
[email protected]
765.494.4004
Training of Partners
• Next level of cessation-shifting focus
from individual to community
• Policy changes drive cessation
• Multi-component programs
• Community wide cessation networks
Indiana Tobacco Prevention
and Cessation
www.itpc.in.gov
317.234.1787