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Tobacco Cessation
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If he can quit, anybody can

Participants in the FirstQuit program have a quit rate—32 percent at six months—that is consistently above the national average for similar programs. But Sallie Beth Johnson, a Community Health Services health educator, knows the program is really working well when it helps a true diehard smoker go tobacco-free.

“I have been working with one Hoke County gentleman since 2006,” Johnson says about the long-term smoker. “It started when he was a patient at Moore Regional Hospital, and every single provider that was working with him asked him about his tobacco use.”

The man was in the hospital because of a heart attack, and he shared a room with another smoker who was not faring very well. “He came to me, and he had never tried quitting,” says Johnson. “He was very pro-tobacco and smokers’ rights—one of those who says ‘they’ll never tell me to quit’—so he was a little skeptical at first in terms of participating.”

The man’s first attempt went well for a couple of weeks, and then he relapsed. “But he came back, and now he’s been almost two years tobacco-free,” Johnson says. “The nurses in the clinic say: ‘If he can quit, anybody can.’”

This kind of success is the result of a program that served 407 new participants in 2007 and uses evidence-based strategies to help tobacco-users develop a quit plan. The program, valued at $320 per participant, costs only $50. That includes six months of ongoing education, medication and support.

Reduced fees are available to those who qualify. FirstQuit is very individualized. Health educators help tobaccousers identify the reasons they want to quit and the triggers that cause them to use tobacco. “Then we start brainstorming and problemsolving with them for coping strategies, things that they can do instead,” Johnson says.

Health educators help participants determine what medication or nicotine replacement therapy will work for them. They also identify who can be the person’s “cheerleader” when things are going well or when they are having difficulty, as well as identifying rewards for when they hit milestones without using tobacco.

“The last part of the quit plan before we help the individual decide on a quit date is we help them brainstorm ways they can prevent or deal with a relapse if they return to tobacco,” Johnson says.

“The research says it takes five to seven serious quit attempts for an individual to be tobacco-free, and our program recognizes the realities of that.”

Johnson’s Hoke County patient has struggled with relapse over the last two years, but he has been one of the program’s great success stories and is now a strong advocate for others. “He’s been quite a champion in terms of coming to support groups and taking a lead there in motivating others,” she says.

Taking tobacco-use prevention to teens

Union Pines High School senior Krystal Knight considers it something of a mission to help others stop using tobacco.

“I hate smoke, because I’ve had to deal with it my whole life,” says Knight, whose mom and other family members smoke. “There are too many smokers and people who chew at the school. It’s a bad habit to start, and it’s supposed to be a smoke-free campus.”

Last year, Knight worked with school guidance counselor Renee Green and FirstHealth health educator Brooke Love to start a Teens Against Tobacco Use (TATU) club. Part of FirstHealth’s Teen Tobacco-Use Prevention program, TATU is funded by a grant from the N.C. Health and Wellness Trust Fund.

With 10 students involved, the Union Pines TATU has set up booths during lunch periods and given students bags (also known as “Quit Kits”) with brochures and items (such as rubber bands, straws and chewing gum) to help them stop. The students involved have also collected cigarette butts to increase awareness of how much tobaccouse is going on. They even put the cigarette butts in a jar to be used in front lobby activities such as “Can you guess how many butts are in this jar?”

According to Knight, the most effective outreach has been to neighboring elementary schools as teenagers spread the word about the dangers of tobacco to a younger set of students.

“We went to two elementary schools last year, and we did activities with them and showed them how smoking can influence their lives and their bodies,” she says.

By the beginning of the 2008-09 school year, the Union Pines TATU had grown to 17 students and planned to visit two more elementary schools and a middle school. The group also initiated a “tackle smoking” project to observe how many students were using tobacco at football games and whether increased signage and announcements about the tobaccofree campus would help reduce that number.

Knight thinks that her greatest success has been on the home front, however. “My mom is not smoking a carton a week anymore, and she doesn’t smoke in the house or around me,” Knight says. “She says she’s planning to quit by the end of the semester.”

Smoke free with Home Free

FirstHealth Home Care and the FirstQuit tobacco-cessation program have teamed up to help people in homes visited by home health nurses to stop smoking cigarettes or using other tobacco products. The innovative new program is called Home Free and is supported by a grant from the American Legacy Foundation.

Home Free began as an effort to protect children from the harmful effects of second-hand smoke. Many of the pediatric patients that home health nurses visit are premature newborns, and the nurses find that many of those households include smokers. More recently, the program was expanded to include all adult home health patients.

“We were already teaching the dangers to children of second-hand smoke in the homes we visited, and now we can offer a free, in-home program to parents and others who would like to quit,” says Connie Christopher, associate director of FirstHealth Home Care. “It’s nice to be able to take the program to people in their homes versus their having to come out to the program.”

When an adult patient or a parent or someone else in the home of a pediatric patient expresses a desire to stop using tobacco, a Home Care nurse makes a referral to Cindy Laton, a tobacco treatment specialist in FirstHealth Community Health Services, which coordinates FirstQuit.

“After doing an initial phone survey with someone who wants to quit, I make an appointment to visit them in their home,” Laton says. “I ask about their current health status, their history of tobacco use, when they have been abstinent from tobacco. I also assess nicotine dependence levels, check carbon monoxide levels and try to learn things about their living environment that might help in developing a quit plan. It’s challenging to get a good feel for that when someone is sitting in your office. Meeting them where they live creates a relationship that facilitates a team approach to quitting tobacco and hopefully empowers patients to make important lifestyle changes related to their tobacco use.”

“Our goal is to help individuals stop using tobacco products,” Laton says. “But, as part of the grant, we are also interested in seeing how the quitting process is affected by taking the cessation program into the home.”