By Catherine Saucedo, deputy director of the Smoking Cessation Leadership Center, and Margaret Meriwether, PhD, behavioral health and wellness manager of the SCLC
Nearly 440,000 people die of tobacco-related causes annually in the United States, and more than 8.6 million Americans have a serious, smoking-related illness. Seventy percent of 46 million Americans who use tobacco want to quit, but only 2.5% are able to do so on their own. Three factors have been shown to be powerful motivators in helping smokers quit: advice from a health care professional, use of a support system such as a telephone quitline, and certain pharmaceuticals.
The Smoking Cessation Leadership Center (SCLC), based at the University of California, San Francisco, has been deploying a key weapon in the fight against tobacco — intervention by health care professionals — to help smokers find the effective, lasting smoking cessation treatment they need. Every day dental hygienists, pharmacists and a host of other health care professionals see smokers. Studies show that interventions by clinicians can double a smoker’s chance of trying to quit.
Dr. Steven Schroeder, SCLC’s director, is more aggressive in helping smokers quit. “Clinicians often fail to treat patients who smoke for a variety of reasons, including lack of time, fear of offending patients, and lack of training,” he says. The Center has worked with a myriad of clinical groups, including behavioral health care providers, to bring down barriers, forging relationships with health care institutions and professional organizations to help facilitate those interventions.
As part of a social marketing effort, the SCLC has been promoting one of the most effective, yet underutilized, smoking cessation resources: telephone quitlines. These toll-free counseling lines, offered on both a statewide and national basis and available to all Americans simply by calling 1-800-QUIT NOW, have been shown to at least double the chances that a smoker will quit.
The clinical guideline for treating tobacco dependence recommends a multi-step process known as “the 5A’s” for treating people with tobacco dependence. However, the 5A’s method was often dismissed by clinicians as too time-consuming.
Why Dental Hygienists?
In 2003 the American Dental Hygienists’ Association partnered with the SCLC in a campaign to mobilize dental hygienists to intervene with their smoking patients. The initiative incorporated a three-step, three-minute process, Ask Advise Refer (AAR), intended to help dental hygienists steer smokers to telephone smoking quitlines. Dental hygienists frequently have contact with smokers before major health problems have developed. Half of all smokers visit a dental office each year, and dental hygiene is the most frequently provided service. Dental hygienists typically are educators, counseling about a variety of oral health issues.
The educational savvy of dental hygienists set the stage for the creation of the Ask. Advise. Refer. shortcut to the 5A’s intervention in the clinical treatment guideline. Promoting AAR under the tagline “Three Minutes or Less Can Save Lives” alleviated concerns about the time constraints. AAR saves time and saves lives. Perhaps because of its relative simplicity, AAR has been a durable answer to the complex task of helping people become smoke-free.
New Directions in Tobacco Treatment
Tobacco use has enormous implications for smokers and nonsmokers alike, ranging from cancer to toxic litter. Also, tobacco use is more common in specific populations — from prisons to mental health treatment facilities to the military. In addition, ignoring smoking by particular groups is ethically indefensible, if smoking is considered socially and medically unacceptable for the mainstream. Groups with high smoking rates are often less visible, to the point that smoking may be justified as a tolerable hazard. If daily life is difficult for these groups of people and smoking is a way to cope, then adding chronic disease and compromised physical functioning (the effects of smoking) to an already grim picture is not a solution. When smoking is considered socially unacceptable by mainstream society, smoking as a norm reinforces the cultural message to these groups that they are on the fringe. In this scenario people in specific populations often respond by embracing smoking as a visible sign of nonconformity. In other words, this is why rebels smoke.
When considering the problems that come with tobacco use, it’s easy to fall into blaming and an us-vs.-them mentality. Instead, one way to re-frame tobacco cessation is to address tobacco treatment as part of wellness. Wellness is a hot topic in health care reform and concerns everyone. Moreover, wellness puts quitting smoking in a positive, supportive context that connects the concerns of whole community.
Becoming tobacco-free is a big step toward wellness that has repercussions for smokers, nonsmokers and children. Like the rings of a tree, the negative effects of tobacco use spread out in waves. Smoke negatively directly affects the health of smokers, the health of nonsmokers through second-hand smoke and the health of children and pets through third hand smoke. In addition, smoking impacts the environment because cigarette butts are a major source of litter. So tobacco takes a toll on our society and environment; by the same token, becoming tobacco-free has a positive ripple effect that benefits individuals, families, communities and the earth.
For free resources and more information and on the ADHA Smoking Cessation Initiative visit www.askadviserefer.org. Visit SCLC website at smokingcessationleadership.ucsf.edu for additional low-cost or no-cost resources.
Catherine Saucedo, deputy director of the Smoking Cessation Leadership Center, (left) and Margaret Meriwether, PhD, behavioral health and wellness manager of the SCLC