Trying to quit? Grant award allows the Voinovich School to try new approach to smoking cessation

Corinne Colbert
June 16, 2014

With help from researchers at the Voinovich School of Leadership and Public Affairs, the Ohio Department of Health is trying out a new approach to smoking cessation that it hopes will help the estimated 70 percent of smokers who say they want to quit, but don’t know how.

In April, a team led by Barry Oches, senior research associate at the Voinovoich School, won a $280,000 grant from ODH to implement the program in four Appalachian counties in southeastern Ohio. Over the next year, the team will train healthcare providers in Lawrence, Scioto, Gallia, and Ross counties to talk with their patients about smoking and connect them with resources that will help them kick the habit.

“We’re hoping to tap into that 70 percent who want to quit but feel there’s nothing out there to help them or think they will be mocked by fellow smokers,” Oches said.

Specifically, the Smoke-Free Families of Southeast Ohio Project targets women of child-bearing age, between the ages of 18 and 44, in hopes of addressing the harm smoking presents to developing fetuses and to children.

“Smoking during pregnancy is linked to infant mortality, low birth weight, and childhood asthma,” said Voinovich research associate Jennifer Collins.

The program trains health care providers to use an intervention model called the 5As:

Ask if the patient if she smokes. This step not only kicks off the intervention, but also is important in gathering information about smoking behavior at the county level. “This kind of data just isn’t collected in a systematic way now, so we have very sketchy information on county-level smoking rates,” Oches said. Knowing how many people smoke in a given county will help the state better target its resources.

Advise the patient on the risks of smoking and the benefits of quitting. “People expect their healthcare professional to tell them to quit,” Collins said. And research shows it’s effective: just being advised to quit increases quit rates by more than 2 percent; getting in-depth advice that lasts more than 10 minutes increases the likelihood of quitting by over 11 percent.

Assess the patient’s willingness to quit. This is the hinge of the process; badgering a committed smoker does no good. But even for the hard-core smoker, just asking if they want to quit can plant a seed. And that’s important, because ingrained habits like smoking usually aren’t changed on a whim. “This is a known stage of change,” Oches said. “You have to precontemplate changing a behavior before preparing to change it.”

Assist the patient’s attempts to quit. If the patient indicates interest in quitting, the healthcare provider gives information about resources available from the state and county. A primary example is Ohio QuitLine, which is free of charge to the uninsured and pregnant women, as well as covered by Medicaid. Each caller to the toll-free QuitLine works with an individual counselor to create a customized plan to stop smoking. Enrollees who aren’t pregnant also can receive four weeks of nicotine replacement gum, lozenges, or patches at no charge.

“Part of Assist is asking them, ‘What do you think will be different if you quit?’” Collins said. Many smokers light up with co-workers on their breaks and don’t know how their friends will react if they don’t smoke. Smoking cessation counselors, such as those on QuitLine, can suggest alternatives (such as taking a walk) and how to get family and friends to support efforts to quit.

Arrange for follow-up. The healthcare provider lets the patient know that she’ll get a phone call in a couple of weeks to see how her attempts to quit are going. That increases the patient’s motivation to follow through on the doctor’s suggestions and gives the provider a second opportunity to bolster the patient’s resolve.

While the current focus is on training primary care providers, the program could be expanded to include dentists, specialists, and any other healthcare professional a patient might encounter.

The Voinovich team also is reaching out to county health departments and other community health organizations to assemble a county-by-county database of smoking cessation resources. Those lists can be distributed by healthcare providers in their offices and will be posted on a website the team is setting up.

“The intent is to create a county-based system where healthcare professionals implement the same intervention and collect the same data,” Oches said. “ODH wants to show that this model works and that there is local infrastructure to sustain it. Our task is to set up a sustainable program that ODH can take and shop around to other counties.”