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The American Psychiatric Nurses Association, in partnership with the Smoking Cessation Leadership Center , convened a Smoking Cessation Summit on Feb. 14-16, 2008, in Lansdowne , VA. Fifteen psychiatric nurses leading tobacco control programs across the nation were chosen from a pool of applicants for this special event. The group organized a Tobacco Dependence Task Force and set the following targets:
- Increase by 5% every year the percentage of psychiatric nurses who do brief interventions (Ask, Advise, Refer) with their patients who smoke, from 61% to 75% by 2012.
- Increase by 5% every year the percentage of psychiatric nurses who do intensive interventions (5As) with their patients who smoke, from 29% to 45% by 2012.
The APNA Tobacco Dependence Task Force believes that the time to act is now and that failure to act equals harm . As such, the group will build upon the strategies identified to:
- Link with existing state tobacco control efforts via partners of SCLC
- Create and disseminate a position paper
- Promote a media campaign by raising awareness through education and other avenues
We applaud the American Psychiatric Nurses Association for its mission to promote and improve mental health, which includes the reduction and elimination of tobacco use. If you wish to learn more about APNA's efforts and/or to join this initiative, please contact Patricia Black at pblack@apna.org or Reason Reyes at reason.reyes@ucsf.edu.
The American Academy of Family Physicians' Ask and
Act campaign seeks to mobilize the AAFP's 94,000 members to ASK
about their patients' tobacco use, then to ACT to help them quit.
Studies have proved that a physician's advice to quit is an important
motivator. Family physicians, then, have a tremendous opportunity
to make a significant impact on the smoking habits of Americans,
as nearly one in four office visits is made to a family physician.
That's 223 MILLION opportunities each year to intervene!
With a goal to have 100% of Family Physicians asking their patients if they smoke and 100% taking further action, the AAFP Ask and Act campaign has launched several activities to help family physicians
and their practice teams help patients kick the habit:
- Formed a national AAFP Tobacco Cessation Advisory
Committee
- Created a tobacco cessation website with free online
materials physicians can print out or order to use in their practice.
- Developed and distributed quitline referral cards.
- Identified opportunities for evidence-based cessation
education, including the AAFP's first CME Webcast.
- Encouraged tobacco cessation education programs
in medical schools and family medicine residency programs.
- Launched a promotional campaign encouraging
family physicians to Ask and Act.
For more information, visit www.askandact.org
In September 2005, SCLC sponsored a smoking cessation
summit at the American Academy of Physician Assistants in Alexandria,
Virginia. The summit was part of the PA Foundation adherence initiative,
an ongoing effort to promote provider and patient adherence to effective
healthcare practices and improve health outcomes. The workgroup
of PA experts in all areas of PA practice established baselines
of both awareness and action among physician assistants regarding
tobacco intervention and set both quantitative and qualitative targets
of improvement over three years.
The action plan to meet these targets encompassed
four action areas:
- Increase awareness of all PAs of the benefits
of smoking cessation for all patients and increase integration
of smoking cessation practices into PA practice in all specialties
and settings
- Facilitate PA utilization of “best practices”
in smoking cessation by providing PAs evidence based tools appropriate
to any patient care setting
- Support education of every PA student on effective
strategies for smoking cessation
- Assist PA organizations to identify and develop
productive partnerships with organizations that share the PA goal
of smoking cessation
AAPA is actively engaged in achieving these goals
through various means.
- The PA workgroup on smoking cessation chose to
adopt the brief intervention model, Ask – Advise –
Refer. The model is effective for all patients in all healthcare
settings.
- All PAs will have access to a range of AAPA sponsored
or approved CME offerings concerning multiple aspects of smoking
prevention and cessation management. Topics will include pharmaceutical
treatment strategies, smoking in minority populations, incorporating
guidelines into clinical practice and others. PAs will receive
this critical education from AAPA through live programs, print
journals, and online offerings.
- AAPA will make effective practice tools and cessation
information available to all PAs.
- AAPA will seek to partner with other healthcare
professional societies to disseminate effective cessation management
strategies throughout the healthcare delivery system.
- The PA Foundation will identify and support community-based
initiatives directed by PAs that seek to increase smoking prevention
and improve cessation efforts.
- AAPA specialty organizations will be involved
in selection and development of smoking cessation information
for PAs and patients. As a result, PAs in all specialty practice
areas will be able to effectively address smoking cessation.
- State PA organizations will have opportunity to
participate on multiple levels. Annual state conferences will
include presentations on cessation strategies for the clinic and
updates on community tobacco control efforts. State PA organizations
will ally with other organizations to encourage better tobacco
control in the community and insurance coverage of cessation treatment.
- PA educators will meet to discuss improvements
in smoking cessation treatment education. Available health professional
curricula will be evaluated and modified as necessary to provide
all PA students with the most current education on smoking prevention
and treatment.
- The Student Academy of the AAPA adopted smoking
cessation as their Healthy People initiative for the 2006-2007
academic year. SAAAPA supports all PA students in eliminating
tobacco from their own lives and in the lives of their colleagues
and patients.
- In the annual PA practice survey, AAPA has expanded
its focus on the clinical management of smoking cessation. AAPA
will learn more about treatment patterns by PAs and opportunities
to optimize health outcomes for patients.
The task force is taking the recommendations through
the official AAPA process and has embarked on an ambitious campaign
to change PA practice. As of May 31, 2006 smoking cessation will
be a major part of any of the organizational and public activities
of the national Phyician Assistant student group and individual
Physician Assistant programs. Specifically, the Student Acadamy
will adopt the following Resolution 2006-2008 as part of the Healthy
People 2006-2007 intiative:
"The Student Academy will promote PA Students
efforts to screen all adult and adolescent patients for tobacco
use and to increase patient awareness as to the dangers in the use
of tobacco. All PA Students should strive to promote cessation of
tobacco use in their own lives and in the lives of their colleagues
and patients. The Student Academy supports education of every PA
student on effective strategies for tobacco cessation including
integration of national and community resources."
In October 2005, SCLC and AARC held a summit at AARC
headquarters in Irving, Texas, to launch a major cessation initiative
among respiratory therapists. The group of 15 (chosen in a competition
from among 60 applicants) identified a baseline of 25 percent of
RTs who do not intervene with smoking patients and set a target
to decrease this amount by 5 percent each year for the next three
years.
The group completed an action plan that contains several key strategies:
- Serve as role models for a tobacco-free
lifestyle by helping smoking respiratory therapists quit
- Identify smokers in hospitals and provide front-line
information and basic counseling on tobacco cessation
- Encourage RT department directors to advocate for
cessation counseling
- Educate RT directors on key
elements of cessation programs and provide specific training
for RTs.
The group set a goal to establish a tobacco-free lifestyle
roundtable within AARC by recruiting 100 champions, and will then
move to establish a larger group and ultimately to secure a seat
for cessation on the AARC board. To learn more about the AARC initiative,
visit www.AARC.org,
and click on the “Community Tab” to join the roundtable.
In 2006, The American College of Emergency Physicians Smoking Cessation Task Force completed its pilot study of Quitline wallet card distribution at 8 US EDs. The study demonstrated the feasibility of distributing the cards, and the willingness of emergency care personnel to deliver an Ask-Advise-Refer intervention. Reports from the project have been presented at annual meetings of the Society for Research on Nicotine & Tobacco and the Society for Academic Emergency Medicine.
ACEP is pursuing funding from industry to print bulk quantities of wallet cards and wall-mounted holders promoting the national Quitline (1-800-QUIT NOW). The cards will be branded with the ACEP logo and the motto "advancing emergency care", and be offered at no charge to interested members. Members will be informed of the cards via a mass mailing (including a sample card) and postings on ACEP's internal communications channels.
ACEP has created a Tobacco Control page in its website under the Practice Resources section. This page includes (1) a link to the task force's white paper, published jointly in Annals of Emergency Medicine and the Journal of Emergency Nursing, and (2) a link to the Smoking Cessation Leadership Center, allowing emergency physicians to access additional materials addressing tobacco control.
We are currently developing a didactic session on tobacco control for the annual ACEP Scientific Assembly.
The SCLC is involved in a partnership with the American
Dental Hygienists’ Association to double the percentage of
hygienists who intervene with their patients on tobacco use, from
25 to 50 percent, over three years.
The ADHA created a tobacco cessation task force that
led the launch of a nationwide effort among the 130,000 dental hygienists,
employing multiple strategies, working through the state affiliate
groups. The hygienists designed a brief intervention called ask-advise-refer
aimed at persuading all hygienists to identify smoking or chewing
patients and referring them to free telephone quitlines.
The effort began when the Center convened a group
of national hygienist leaders in September 2003 to formulate a
comprehensive set of strategies to achieve the goal. At the meeting
a task force statement was generated, and the SCLC agreed to fund an
ADHA staffer to help implement the multi-faceted plan.
The ADHA project has established a state Smoking
Cessation Initiative (SCI) liaison network and is involved
in an array of efforts to implement its ambitious ask-advise-refer
campaign among hygienists nationwide. It has secured corporate
support for the effort from Glaxo-Smith-Kline and the Wrigley
Corporation. ADHA, through its state affiliates, is getting
the 1 800 QUIT NOW card in the hands of hygienists around the
country.
The Smoking Cessation Leadership Center is pleased to be in partnership with the American Society of Anesthesiologists (ASA) to educate and mobilize anesthesiologists to provide smoking cessation counseling and intervention, utilizing pre- and post-surgery consultations as teachable moments. This partnership officially began with a summit in August 2006 under the leadership of David Warner, MD, along with 8 leading anesthesiologists, all who understand and advocate the importance of smoking cessation in surgical practice for both health and healing. A Smoking Cessation Initiative Task Force was established at this summit, which was approved by the ASA House of Delegates in October 2006. This Task Force set a vision that every patient who smokes who is cared for by an anesthesiologist will receive assistance in quitting as an integral part of their care. Their goal is to increase the involvement of ASA members in smoking cessation efforts, with the ultimate goal of increasing the abstinence rates for their patients who smoke.
The ASA Smoking Cessation Initiative Task Force aims to implement the following strategies:
- Encourage all anesthesiologists to consistently apply the Ask-Advise-Refer technique
- Develop anesthesiologists who can serve as leaders for local efforts to provide tobacco intervention services in perioperative practice
- Educate the public regarding the importance of perioperative smoking cessation, and that anesthesiologists care about this issue
- Create partnerships with other healthcare professionals to promote a comprehensive perioperative strategy for patients who smoke
A pilot study was launched in September 2007 to apply the Ask-Advise-Refer intervention at 14 sites across the nation. ASA also supported creation of a 1-800-QUIT NOW quit card specific for their surgery patients. More information on the pilot study will be determined in early 2008. For more information on this initiative, visit the following links:
DBSA, a member of the National Mental Health Partnership for Wellness and Smoking Cessation, is surveying their membership online to determine proper tobacco cessation resources for their audience. DBSA is also working with SCLC to create a curriculum to educate peer specialist about tobacco cessation, who in turn, will work with consumers to tailor recovery plans. Visit their homepage to learn more about DBSA. www.dbsalliance.org
As the nation’s preeminent accrediting
body for hospitals, the Joint
Commission on Accreditation of Healthcare Organizations (JCAHO)
is in a unique position to influence practice regarding tobacco
cessation interventions in healthcare settings.
As a part of the accreditation process,
the Joint Commission now requires hospitals to select and transmit
data on three of five sets of standardized core performance measures.
Three of the five core data sets-acute myocardial infarction, heart
failure and community acquired pneumonia- contain measures that
address smoking cessation, specifically addressing whether cessation
advice or counseling is provided during a hospital stay. In a study
funded by the Center in 2004, JCAHO learned more about differences
related to this intervention and ultimately surfaced new key questions
for further research.
JCAHO surveyed a demographically diverse
sample of 185 hospitals that were selected based upon high or low
performance on their smoking cessation counseling performance measures.
113 hospitals returned surveys.
The survey sought information on the current types of advice/counseling
inpatients with acute myocardial infraction, heart failure or community
acquired pneumonia, receive related to smoking cessation, barriers
to the provision of counseling, staff training, whether or not counseling
is given but not documented, and to what extent is poor performance
based on poor documentation versus poor clinical performance.
JCAHO explored the possibility of identifying
other distinguishing hospital characteristics that either contribute
to, or mitigate against, appropriate compliance with the smoking
cessation performance measure, and specific characteristics common
to both hospitals with high and low rates of performance.
The findings led to the identification
of key strategies that could be used to enhance compliance related
to smoking cessation advice/counseling in the inpatient hospital
setting. This topic was explored in a summit in Chicago in June
2005 involving JCAHO leadership, SCLC staff, and experts from an
array of health professions and other relevant organizations. Key
interventions, based upon study findings, an extensive literature
review, and input from the expert panel became the focus of a follow-upstudy
designed to help hospitals improve their smoking cessation counseling
performance. In this study, which is currently in progress,
lower performing hospital CEOs received a letter from the JCAHO
Division of Research which encouraged them to improve their performance
and included a packet of materials which offered strategies for
achieving this goal. A control group will receive no information
and JCAHO will routinely track ongoing cessation performance of
both groups. Site visits will be performed in a sample of study
hospitals to evaluate hospital responses to the materials provided
and on quality improvement interventions that have been initiated
as a result of JCAHO contact during the study.
The Smoking Cessation Leadership Center
is involved in a groundbreaking partnership with Kaiser Permanente
Northern California (KPNC).
KPNC produced a 30 percent increase in
HEDIS scores (1998-2003) and contributed to a more than 10 percent
reduction in smoking prevalence among its adult members. For its
outstanding work, KPNC has submitted a proposal for the James A.
Vohs Award for Quality. The Vohs Award was established by Kaiser
Permanente “to recognize and honor projects that advance the
quality of care, showcase, innovative techniques, produce transferable
knowledge, and underscore the value of multidisciplinary teamwork.”
The Smoking Cessation Leadership Center
(SCLC) believes KPNC is a model for health care systems nationwide
regarding tobacco cessation. Accordingly, SCLC has challenged
KPNC to work together to reduce its already impressive tobacco
prevalence figure from 12.2 to 10 percent. As of November
2006, the prevalance has dipped below 10% to 9.2%. To
request more information about the KPNC proposal and its impressive
tobacco dependence program, email csaucedo@medicine.ucsf.edu.
It's quitting time L.A.! / Los Angeles County Department of Public Health
On August 2, 2006, LA
County kicked off an aggressive stop smoking campaign targeting
diverse individuals. The Department has called a summit to develop
a plan to address high smoking rates in many of its diverse populations.
While the county’s overall smoking prevalence rate is currently
at 14.6 percent, African Americans in general, and Asian, Latino
and White men still smoke at significantly higher rates. Smoking
prevalence data for populations to be targeted by the new campaign
will be showcased at the summit.
 This unprecedented effort
promises to be the first urban county in the nation to reach
the Center for Disease Control’s “Healthy People 2010” smoking prevalence goal of 12 percent ahead of schedule. The collaborative one-year smoking cessation program seeks to provide quitting assistance to the region’s
more than one million smokers.
Lead by Jonathan Fielding,
M.D., M.P.H. County of Los Angeles, Acting Director of Public
Health and Health Officer, strategic partners include, SupervisorYvonne B. Burke County of Los Angeles, 2nd Supervisorial District,
and Steven A. Schroeder, M.D. Distinguished Professor of Health
and Health Care, Division of General Internal Medicine, Department
of Medicine, UCSF; director of the Smoking Cessation Leadership
Center as well as more than 150 people representing: American
Legacy Foundation, California Dental Hygienist Association, California
Endowment, California Smokers’ Helpline, Campaign for Tobacco
Free Kids, Emergency Room Doctor Association, Family Practice
Physicians, GSK, Kaiser Permanente, LA County Medical Association,
Longs Drug Stores, National Cancer Institute, Nursing Association,
Pfizer, Public Health Dental, Respiratory Therapist Group, UCLA,
UCSF Smoking Cessation Leadership Center, Watts Health Care Foundation
and Wellpoint.
Pfizer, the pharmaceutical giant, is
engaged in several creative ways to drive smokers toward cessation.
Recognizing the power of telephone quitlines as a way to double
or triple chances of quitting-- and to link smokers to Nicotrol
as one of the choices for nicotinereplacement therapy-- Pfizer
representatives have distributed cards advertising the California
Smokers' Helpline to dental offices, and family practitioners, in
California metropolitan areas. The project has been expanded with
the advent of the national quitline number, 1 800 QUIT NOW, and
Pfizer has purchased hundreds of thousands of national quit cards
for distribution by representatives across the country.
Pfizer has also been a partner in the New
California Gold Rush, an effort led by the California Dental
Hygienists Association to have every dental hygienist in the state
give at least one gold card to a smoker within one year. Hundreds
of hygienists handed out thousands of gold cards advertising the
state’s quitline during the competition. The winner, the hygienist
who handed out the most cards to smokers, has won a trip to the
2006 World Conference on Tobacco or Health and will be honored at
the CDHA annual meeting in Redwood City in November 2005.
Most recently, Pfizer has released
Chantix, the
new prescription medication for smoking cessation. For detailed
patient or provider information or to view a copy of the press
release about the drug from the Medical Team Leader of Pfizer,
Inc. please download the following PDF files.
In October 2004 SCLC convened a group
representing aspects of pharmacy ranging from academic, community
and hospital pharmacy to independent and chain drug stores and pharmaceutical
companies. The group established a baseline that six percent of
patients reported being asked about smoking by pharmacists and set
a target to increase that to 20 percent over three years. SCLC funded
implementation of the action plan that was developed in a grant
to the American Society of Health-System Pharmacists.
The Partnership has already developed
a CEU course for distribution nationwide, has established a speakers’
bureau, is expanding use of the Rx
for Change curriculum to educate various groups of health professionals,
and is working to develop additional resources and messages for
the pharmacy profession. More recently, Frank Viatale, director of the Pharmacy Partenrship is working with Glaxo-Smith Kline to get cessation booths set up at Nascar racing events. For more information contact Frank Vitale at vitalef@pitt.edu or call 412-383-7206.
ke it Your Business Campaign:
The Make It Your Business campaign continues to urge companies, labor organizations, and states to routinely cover and promote tobacco cessation benefits and services. The national campaign, formerly based in Oregon, now is part of the Seattle-based Healthiest State in the Nation Campaign. The Employer’s Toolkit describes why businesses want to invest in a tobacco-free workforce and how human resources and communications managers can work together to design and promote an effective benefit. www.makeityourbusiness.net
Make It Your Business partners employ a variety of strategies. In 2007, they are pursuing two parallel strategies:
- Step Up! works with hospitals as businesses. We support hospitals with tools and training to create tobacco-free campuses, help employees and patients quit tobacco, and lead communities in curbing tobacco use. We have conducted a survey of Oregon hospitals, held two web conferences, and developed a toolkit—all posted on the Oregon hospital association website www.oahhs.org and linked to the Joint Commission’s WikiHealth. In October, the Pharmacy Partnership for Tobacco Cessation, will conduct a train-the-trainers session with Oregon hospital clinician leaders.
- A new on-line quit-tobacco tracker supports tobacco-users to quit. Tobacco-users receive points for setting a quit date, getting evidence-based help, and for each day they stay quit. S mokers nationwide can use the tracker as part of an array of on-line tools for Healthy Living created by the Healthiest State in the Nation Campaign. Roughly 30,000 people use trackers to set personal goals and measure progress on health-related goals, including exercise, reaching a healthy weight, and drinking water. Teams of individuals, organizations or businesses then engage in “healthy competition” with others through the Healthiest State Campaign. www.healthieststateinthenation.net
We will facilitate a session at the 2007 National Conference for Tobacco or Health, partnering with the Joint Commission, a successful tobacco-free hospital effort in North Carolina, and an Oregon health system that integrates cessation into employee benefits and patient care.
Contact: Dawn Robbins, dawn@tobaccofreeoregon.org 503-774-4146.
SCLC funded a summit including 21 nursing organizations
in March 2004. The participants developed an action plan for
each professional group to carry back to its own organization
and proceeded with implementation. SCLC has provided three
years of funding to the leadership and advocacy initiative
that is part of the broader Tobacco Free Nurses, which aims
to help nurses quit smoking.
TFN has a comprehensive web site at tobaccofreenurses.org.
It has developed a pocket guide summarizing the Five A’s
protocol for use by nurses nationwide. It has greatly raised
the profile of nurses as cessation interventionists and is
spreading the word among the nation's 2.2 million nurses that
they should be activists regarding cessation
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