We look forward to hearing your comments and suggestions, as we work towards the next decade of milestones.
#10 Milestone and Emerging Direction
Milestone: Articles in the scientific literature.
Since its inception in 2003, SCLC has published 56 papers that cover multiple facets of tobacco use and cessation. These publications have appeared in prominent journals, such as New England Journal of Medicine (11 publications), Journal of the American Medical Association (4 publications), Annals of Internal Medicine, Archives of Internal Medicine (now JAMA-Internal Medicine), and Health Affairs. These articles have sparked stories in the lay press, including The New York Times. Many have appeared in specialty journals representing SCLC’s various partners. These publications have helped to keep the problem of tobacco use on professional, lay, and health policy “radar screens”.
Emerging Direction: Incarcerated populations.
Many incarcerated people have drug or alcohol problems, and thus have a high smoking prevalence. As more prisons and jails go smoke-free, these persons will face issues of either giving up smoking or turning to contraband as a way of obtaining tobacco products. In addition, even if they are able to become smoke-free while incarcerated, many will be tempted to resume smoking after discharge. We would like to engage those involved in caring for these populations in a dialogue about how to help this population quit smoking.
#9 Milestone and Emerging Direction:
Milestone: Amplifying the voices of tobacco champions.
All of our milestones relied on the dedicated work of smoking cessation champions. We have been fortunate in identifying many such champions and working with them to expand smoking cessation activities within their organizations and communities. In many instances they were unsung heroes and heroines, but they were positioned to become catalytic change agents. Rather than try to single them out individually, we hereby salute them and thank them for their dedication. It has been an honor to work with them, and we pledge to keep supporting their amazing efforts.
Emerging Direction: Addressing tobacco use among low SES and disabled populations living in low income housing.
Many persons with low SES and disabilities live in public supported housing, where smoking prevalence can be high. As part of the burgeoning clean indoor air movement, there is increasing interest in making these facilities smoke-free. The SCLC would like to be a part of that movement.
#8 Milestone and Emerging Direction:
Milestone: Collaborating with Pfizer to distribute grants for smoking cessation.
In 2012, the Pfizer Independent Grants for Learning and Change (formerly the Medical Education Group) and SCLC collaborated to award over $4.5 million in grants focused on smoking cessation to 39 organizations nationwide. The grantees fell into three categories: individual institutions or specialty societies (17); hospitals interested in adopting the Joint Commission’s tobacco cessation measure (10); and state efforts to reduce smoking among behavioral health populations (12). This was an unusual collaboration between an academic organization and a pharmaceutical company since there was no financial remuneration given to SCLC by Pfizer. SCLC is providing ongoing support to the 39 grantees and a conference for the grantees will be held in the next year.
Emerging Direction: Further adoption of the Joint Commission (JC) Tobacco Cessation Performance Measures.
Smoking cessation is currently one of 14 possible measure sets by which the JC will assess hospital performance, of which hospitals must choose four. To date, most hospitals have not elected to choose the smoking cessation set, possibly because it entails tracking smoking status after hospital discharge. There are currently discussions with other regulatory organizations regarding how this uptake could be accelerated, and it is possible that CMS will include smoking cessation as part of its Hospital Inpatient Quality Reporting System. Furthermore, ten hospitals received Pfizer Medical Education Group grants in 2013 to explore this issue. We would like to do further work in this area so that more hospitals can do the right thing and help their patients stop smoking.
#7 Milestone and Emerging Direction:
Milestone: Involvement in place-based initiatives.
SCLC has been involved in several place-based smoking cessation initiatives. A major one was “It’s Quitting Time, LA!” a smoking cessation campaign started by Los Angeles County. In August 2006, the LA County Department of Public Health convened a summit to develop a plan addressing the high smoking rates among its diverse populations. The efforts from this summit and campaign resulted in LA County being the first urban county in the country to reach the Center for Disease Control’s “Healthy People 2012” smoking prevalence goal of 12% ahead of time. Other regional initiatives on which SCLC partnered include Washington state, which held an event with 30 state leaders called “Washington Quits!” that had a target of reducing tobacco use in the state by at least 3% a year (from 17% in 2006 to under 15% by 2010). Oregon convened a group of leaders in 2009 for its “Oregon Tobacco Freedom” summit, which resulted in strategies to improve access to and participation in tobacco cessation programs. Also, the Indiana Tobacco Prevention & Cessation Program (ITPC) was formed in July 2011 to change the cultural perception and social acceptability of tobacco use in the state, as well as prevent initiation of tobacco use by youth, assist tobacco users in cessation, assist in reduction and protection from secondhand smoke, and eliminate health disparities related to tobacco use among at risk populations.
Emerging Direction: Expand work with HRSA.
The Health Resources and Services Administration (HRSA) is responsible for funding and supervising over 3,000 grantees nationwide who serve millions of people annually. Because many of HRSA’s clients come from lower socioeconomic levels, they have a higher proportion of smokers than the general population. Recently, HRSA has announced its intention of assessing each clinic on its performance in smoking cessation. The SCLC has provided some educational assistance to HRSA clinicians regarding smoking cessation. We would like to broaden and intensify that assistance.
#6 Milestone and Emerging Direction:
Milestone: Collaborative work with SAMHSA.
SCLC and the Substance Abuse and Mental Health Services Administration (SAMHSA) worked together to target tobacco use among SAMHSA’s grantees. This allowed SCLC the opportunity to direct small SAMHSA grants to 100 existing grantees that wanted to expand their smoking cessation activities, known as the ‘100 Pioneers’ initiative. In addition, SAMHSA delegated to SCLC the challenge of convening eight state summits that brought together multiple agencies with the target of increasing smoking cessation attempts in behavioral health populations. Attendees included representatives of state public health authorities, substance abuse and mental health agencies, tobacco control departments, state quitlines, treatment facilities, NGOs, and advocacy groups such as the National Alliance on Mental Illness. At each summit, the participants used the SCLC’s Performance Partnership Model to estimate baseline smoking rates, set targets to reduce those rates by a certain date (generally 3 to 5 years) and agree on a set of strategies to achieve the desired target(s). SCLC selected the states, organized the summits, attended them, and provided technical assistance afterwards. The summit states were New York, Arizona, Oklahoma, Maryland, Texas, North Carolina, Arkansas, and Mississippi.
Emerging Direction: Include smoking cessation in AA and other 12-step programs.
Twelve-step programs such as Alcoholics Anonymous have enormous potential to help their members stop smoking and thus improve their health and longevity. However, the culture of anonymity and decentralization that has been such an important feature of AA’s success it impedes efforts to engage in smoking cessation. Our vision is a simple one: provide information on smoking cessation, including how to access 1-800-QUITNOW, for those attending AA meetings who may be interested in quitting. We would like to pilot this in one or more local affiliates, and ask for your help in making that happen.
#5 Milestone and Emerging Direction
Milestone: Smoking Cessation Leadership Center’s educational offerings.
These include a popular webinar series, a highly viewed webpage, a periodic communique sent to our listserv, custom toolkits, a catalogue of tools, and technical assistance to a wide variety of users. The webinars, begun in 2007, have included 32 separate presentations, covering a wide range of topics on tobacco addiction and recovery. The webinars include nationally recognized tobacco control experts who offer the latest information for general and behavioral health registrants. The topics range from pharmacology to advice on staging interventions with patients who smoke. SCLC also offers CME/CEUs for all live and select recorded webinars, which average about 500 registrants. The Catalogue of Tools is an annually updated document that includes many smoking cessation resources for health professionals of various specialties, including toolkits, information on many place-based initiatives, the Performance Partnership Model used to convene strategy summits, and materials for behavioral health providers. SCLC’s website has also served as a useful hub of information and resources for both health providers and consumers. The website contains recordings of webinars, along with publications from SCLC staff and its partners. The site is currently being updated to a new and cleaner format, so please stay tuned for unveiling of the new SCLC website.
Emerging Direction: Reduce tobacco use by college students.
An encouraging recent trend is the decline in smoking rates among youth, as well as the shift from daily smoking to intermittent smoking. That said college campuses comprise locations for many young smokers. Increasingly there is interest to help these students quit and to protect their non-smoking friends and associates from exposure to second-hand smoke through change of campus policy. As a result, more campuses, including the University of California system, are going smoke free. The SCLC would like to advance this movement.
#4 Milestone and Emerging Direction
Milestone: Marketing Rx for Change: Clinician-assisted tobacco cessation.
Rx for Change is a tobacco cessation curriculum designed by UCSF pharmacists Karen Hudmon (now at Purdue), Lisa Kroon, and Robin Correlli to enhance tobacco cessation skills of health professionals. The curriculum has been modified for various healthcare providers, including psychiatrists, cardiologists, mental health peer counselors, surgeons, and those working in cancer treatment. The Rx for Change website contains all of the educational materials tied to the curricula, and registration is free. The Rx for Change curricula are available in both the 5A’s format and Ask, Advise, Refer. The curricula are based on the Clinical Practice Guideline for Treating Tobacco Use and Dependence.
Emerging Direction: Ban cigarette sales from chain pharmacies nationwide.
One of SCLC’s partners, Dr. Mitchell Katz, now Commissioner of Health Care for Los Angeles County and formerly Commissioner of Health for San Francisco County, gave an SCLC webinar on how San Francisco banned the sale of cigarettes from pharmacies. The rationale, as Dr. Katz explained in his webinar, was that pharmacies should be institutions that promote health, not disease. We have encountered increasing interest among large chain pharmacies in following the example of San Francisco on a national scale, and are eager to assist in those efforts.
#3 Milestone and Emerging Direction
Milestone: Ask, Advise, and Refer as an acceptable cessation strategy, including promoting the national quitline (1-800-QUIT-NOW).
Prior to the creation of SCLC, the only official guideline offered to clinicians was the laudable but time-intensive 5’As. Initially developed by the American Dental Hygiene Association, Ask, Advise, Refer provided an evidence-based alternative that took much less clinician time because the quitline would perform the final three A’s (Assess, Assist, and Arrange). The “Ask, Advise, Refer” model was first introduced in 2003 and has since spread nationwide as well as being formally included in the 2008 revised USPHS Clinical Practice Guideline. One of the primary obstacles that smokers faced when they wanted help quitting was finding a local or state quitline that could aid them. SCLC made the quitline referral process much easier for smokers by developing a credit card-sized blue card that promotes the national quitline, 1-800-QUIT-NOW. This number is a national router that accepts callers from across the nation and seamlessly directs them to the appropriate state-run quitline. If there is no state quitline for the caller, the call will be redirected to the National Cancer Institute (NCI) quitline. SCLC provides the blue 1-800-QUIT-NOW cards at cost and takes orders for those who would like to use them.
Please follow this link, http://smokingcessationleadership.ucsf.edu/cardorderform.htm, to submit your order request online. There are currently over 5 million blue cards in circulation (including over 1 million at VA facilities nationwide), with all types of health professionals, counselors, and peers using them to help with cessation.
Emerging Direction: Extend the reach of quitlines.
Despite the proven efficacy of toll-free telephone quitlines, only about 1% of smokers use them, and less than 5% are aware of their existence. Too many clinicians are also unaware of quitlines. Public awareness has been hampered by recent cuts in state tobacco control budgets. In association with groups like the North American Quitline Consortium, the SCLC would like to help make quitlines more visible for smokers, their families, and clinicians.
#2 Milestone and Emerging Direction
Milestone: Productive partnerships with health professional societies to promote smoking cessation.
Previous smoking cessation efforts mainly focused on primary care physicians. SCLC, however, has enlisted over 80 organizational partners to elevate the prominence of smoking cessation among their members. A partial list of successful collaborations includes the American Academy of Family Practice, American Association of Respiratory Care, American College of Emergency Physicians, American Dental Hygiene Association, American Psychiatric Nurses Association, National Alliance for Mental Illness, and National Association of State Mental Hospital Program Directors. These partnerships, which helped to stimulate smoking cessation efforts by members, are critically dependent on key champions within the societies.
Emerging Direction: Continued work with targeted health professional groups.
There remain certain health professional associations with which we have had minimal opportunities to provide technical assistance. Among these are the American College of Physicians, the American Dental Association, the American Nursing Association, and the various surgical societies. We will be looking for opportunities to engage these organizations further.
#1 Milestone and Emerging Direction
Milestone: Helping to incorporate smoking cessation into mainstream treatment of mental health disorders and addictions.
Before SCLC’s involvement in 2007, smoking cessation was minimized as a valid concern among the behavioral health community. Many of the organizations and staff working in behavioral health regarded smoking as an accepted part of the landscape. There were suspicions that stopping smoking might worsen the underlying condition, as well as pressures by advocates to not deprive these smokers of a pleasurable activity. Through convening, advocacy work, and technical assistance, an increasing number of organizations have now embraced smoking cessation for this vulnerable population, who account for such a high proportion of tobacco use. These changes bring the promise of reducing smoking-attributable death and disability. Some of SCLC’s partners in this effort include SAMHSA, NAMI, the National Association of State Mental Health Program Directors (NASMHPD), CDC, Community Drug Coalitions of America (CADCA), and the American Psychiatric Nurses Association (APNA). In addition, through our work with the Behavioral Health Advisory Forum, we offered quitline vendors suggestions for screening, treatment, staff training, evaluation, research, and community referrals for the many callers with behavioral health issues.
Emerging Direction: Continued work with behavioral health professional groups, including the military and Department of Defense (DoD).
In addition to our work with the APNA, NASMHPD, DBSA, and the National Council for Behavioral Health (National Council), the SCLC would like to engage other behavioral health professional groups. These include the American Psychiatric Association, the American Psychological Association, and the National Association of Social Workers. We will continue to identify and promote best practice strategies and resources such as the DoD tobacco cessation website ucanquit2.org to increase tobacco prevention and cessation in military communities and review opportunities, such as Project UNFORM, for military-civilian partnerships to address tobacco. Enlisting these important groups and their members in helping smokers quit would enhance the growing movement to reduce smoking among behavioral health populations.