FirstHealth’s quit-tobacco program still affecting lives after 10 years

PINEHURST – A personal issue turned into a professional dilemma for Rora Kellis when FirstHealth of the Carolinas became North Carolina’s first tobacco-free health care system in 2004.

As an employee of FirstHealth’s security department, Kellis was a member of the team that would enforce the tobacco ban at Moore Regional Hospital.

He was also a two-plus-pack-a-day smoker.

Kellis figured the only fair thing for him to do would be to give up his own tobacco habit. “I felt the only way I’d be able to (enforce the tobacco ban) with any kind of conscience would be to quit myself,” he says.

A smoker since his early teens, Kellis entered FirstHealth’s FirstQuit program not only expecting to fail but also at odds with the no-tobacco policy. People aren’t at a hospital because they want to be, he reasoned, but because they have to be. It hardly seemed fair to ask them not to use tobacco at a time of personal difficulty.

“We tell them they can’t do something that is a stress-reliever for them,” he says. “The only way to strengthen my argument was to go to the tobacco-cessation classes and say, ‘See it didn’t work.’”

Except that the classes did work.

Kellis gave up smoking in March 2004. He credits his success to the individualized approach that FirstQuit offers each of its participants – more than 3,200, to date.

“They didn’t tell me this is how you’re going to do it,” Kellis says. “It didn’t work that way. They asked me what I thought. They got my buy-in by asking me. Now it’s hard for me to remember what it was like to smoke.”

By the time that FirstHealth of the Carolinas “declared its independence from tobacco” on July 4, 2004, its Community Health Services department had been offering quit-tobacco classes for about three years. A 2001 grant from the American Legacy Foundation, using funds from the national tobacco industry settlement, had provided the money for quit-tobacco classes offered through local provider offices and worksites.

In 2003, as FirstHealth prepared to take its campuses tobacco-free, the quit-tobacco program officially became known as FirstQuit. Additions to the program included a support group, medication assistance and group classes. The program was also opened up to participants in the general community beyond provider referrals and worksites.

“When we were developing the program, we researched the best practice models of the time and incorporated the information into our situation,” says Chris Miller, director of FirstHealth Community Health Services.

The result was a program that focuses on each individual entering the program and his/her unique quitting experience. FirstHealth also began to provide technical assistance to other hospitals and worksites interested in going tobacco-free. As an organization headquartered in a historically recognized tobacco county in a historically recognized tobacco state, FirstHealth had valuable information to share from its tobacco-free experience.

“FirstQuit was an actual piece of that whole process,” Miller says.

Today, FirstHealth Community Health Services has six health educators with national certifications as tobacco treatment specialists. Five were trained by the Mayo Clinic, and one earned her certification from the University of Massachusetts.

As they strive to be non-traditional in the way they deliver services, they go into churches, community health care clinics, worksites and group homes, anywhere a group of people has indicated a willingness to learn more about quitting tobacco. Their message focuses on tobacco-use as an addiction that can become ingrained in the user’s daily life.

Many worksites throughout the FirstHealth service area have welcomed the FirstQuit program as a benefit of FirstHealth’s FirstCarolinaCare Insurance Company. Others have no FirstHealth affiliation, but want to offer assistance to their employees as their location becomes tobacco-free.

“We try to approach tobacco as a chronic disease,” says certified tobacco treatment specialist Cindy Laton. “Just as with other chronic diseases, relapse is something that happens and we try to help people understand that this is something they may have to manage their whole life.”

As more and more businesses become tobacco-free and with the 2010 North Carolina state law banning smoking in restaurants and bars, people have lots of reasons to give up tobacco. “Most people are at least willing to talk about it,” says Laton.

But others continue to resist. “The thought of quitting can be scary,” says certified tobacco treatment specialist Lynn Antil. “We want people to know there is support available if they want to quit.”

According to the health educators, it usually takes several attempts, often accompanied by different approaches, for a user to become tobacco-free. “It’s more common for it to be multiple times,” Antil says. “Every time you try, your chances are a little bit better because you learn from past experiences.”

In a recent expansion of the FirstQuit program, Moore Regional and Richmond Memorial hospitals have begun offering inpatient bedside consultations for tobacco-using patients. Miller says these efforts have put FirstHealth “ahead of the game” for the expected 2012 addition of inpatient tobacco-cessation programs to The Joint Commission’s list of performance measures for nationally accredited hospitals.

The effort takes the input and effort of many people. “FirstHealth’s hospitalists and nursing staff have been instrumental in helping make the inpatient FirstQuit program a success and will be part of the process to make it stronger,” Miller says.

Former smoker Rora Kellis, who no longer works for FirstHealth, says FirstQuit gave him the tools to give up his tobacco habit and quitting gave him the means to renew his interest in a pastime that he hadn’t enjoyed for a while.

He figures giving up cigarettes – at $5 or so a pack – has saved him more than $1,800 a year over the past 10 years.

“I think it paid for my motorcycle,” he says.