When the Smoking Cessation Leadership Center at UCSF began in January, 2003, it was founded on an unproven assumption: that there was a need to assist clinicians and other groups to improve the practice of smoking cessation. Created with a five-year grant from the Robert Wood Johnson Foundation (RWJF), SCLC’s initial strategy was to contact clinical organizations—especially primary care physicians—and convince them that there was more to be done to help their members become better at providing smoking cessation services. SCLC would then deliver technical and organizational assistance. As with many behavior change efforts, we had to make course corrections as we encountered implementation obstacles, including the perception that clinicians were too busy to become smoking cessation experts, that many were skeptical about whether people who smoked really want to quit, and that the added health benefits from quitting were not worth the trouble.
Beginning with the American Dental Hygienists’ Association, we evolved the following set of strategies:
- Making it easier for clinicians to help patients stop smoking, with special emphasis on educating about telephone quitlines.
- Expanding the network of practitioners helping people to stop smoking.
- Stimulating governmental and not-for-profit agencies to become more invested in smoking cessation.
- Forging smoking cessation partnerships with businesses, including working with CVS Health to stop selling tobacco products and partnering with Pfizer (on a voluntary, unpaid basis) to distribute $6.6 million in smoking cessation grants.
This set of activities and strategies is summarized in Helping smokers quit: New partners and new strategies from the University of California, San Francisco Smoking Cessation Leadership Center.
Although we were aware of the very high burden that smoking exerted on persons with mental illnesses and substance use disorders, in our first few years we largely avoided this population, based on the advice of experts. But in 2007, with additional support from the then American Legacy Foundation (now Truth initiative) we began an intensive effort with the behavioral health community. This work, summarized in Helping smokers quit: The Smoking Cessation Leadership Center engages behavioral health by challenging old myths and traditions, involved a partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA), culminating in the 2018 SAMSHA designation of SCLC as The National Center of Excellence for Tobacco-Free Recovery, as well as working with other governmental and non-governmental organizations, behavioral health professional societies, and joining with the American Cancer Society to create the National Partnership on Behavioral Health and Tobacco Use.
Much has happened in the almost 17 years since SCLC was founded. The U.S. adult smoking prevalence has fallen from 22 to 14%, and the number of adults who smoke has declined from 45.4 million to 34 million in the face of a rising population. In addition, smoking has become more and more concentrated among vulnerable populations, including those who are poor, have low educational levels, suffer from homelessness, mental illnesses, substance use disorders, or are incarcerated.
Because these populations have so little political clout, smoking has receded as a salient policy issue. One new development, however, has the potential to revitalize tobacco control. The introduction of electronic nicotine delivery devices, while causing a huge controversy over their benefit/risk ratio, has stimulated renewed interest in tobacco use and the harm that it causes. Closer to home, UCSF is now undertaking a search to replace me as SCLC director. The Center is in great shape, being supported by multiple entities including SAMHSA, the state of California, the American Cancer Society, and the National Council for Behavioral Health, and the director’s position is supported by the equivalent of an endowed chair (from RWJF). It enjoys an outstanding staff of 7 devoted professionals, led by Deputy Director Catherine Saucedo, who are energized by its mission of helping people quit smoking. The search is led by Mitchell Feldman, MD, Professor of Medicine and Chief, Division of General Internal Medicine. Details can be found here: https://aprecruit.ucsf.edu/apply/JPF02620.
I have been fortunate to have led a very full professional life. Leading the SCLC has been one of the most rewarding things I have ever done, mainly because it affords the chance to work on such an important issue and with such great people, both at UCSF and nationally. Whoever is lucky enough to become the next director is in for a treat. I anticipate that the handoff will occur sometime next summer. In the meantime, I will stay involved in the vital work that we do.