Running head: Tobacco Cessation 1

Bryant Rueda

HSC 435 Section 03

Best Practices Research Paper

Tobacco Cessation

Word Count: 1,964

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Healthy People 2020 states that more than 20 million Americans have died at the hands

of smoking since the first Surgeon General’s report on tobacco in 1964 (Healthy People 2020,

2018). Unfortunately, smoking is an epidemic which kills more than 7 million people worldwide

every year (World Health Organization, 2018). The goal of Healthy People 2020 is to “Reduce

illness, disability, and death related to tobacco use and secondhand smoke exposure” (Healthy

People 2020, 2018). Tobacco use is the largest preventable cause of death in the United States,

attributing to the death of about 480,000 Americans (Healthy People 2020, 2018). Diseases

caused by tobacco use are many types of cancers, heart disease, stroke, lung diseases, diabetes,

and more. For this reason, I chose to study different intervention methods for tobacco cessation.

The target population I chose was based on age; the following intervention studies vary in age,

culture, and sex.

Literature Review

Since tobacco use affects many different individuals, there have been a wide variety of

prevention programs with the goal of tobacco cessation. The journal article, “Effectiveness of a

Culturally-Tailored Smoking Cessation Intervention for Arab-American Men” (Haddad, Al-

Bashaireh, Ferrel, & Ghadban, 2017) mentions how the Transtheoretical Model (TTM) was

applied to the cessation program. The program focused on this population because the prevalence

of smoking among Arab-American men is high (63% men, 10% women) (Haddad et al., 2017).

This program had three components which included motivational interviewing, workbooks (in

Arabic) with strategies to aid in the advancement of the different stages of the (TTM), telephone

counseling, and nicotine replacement therapy (NRT). The researchers tailored all components of

the program to reflect values, norms, and experiences of Arab-Americans (Haddad et al., 2017).

The workbooks taught problem-solving and relapse prevention methods, suggested different
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activities to help deter smoking, and provided information about the negative effects of tobacco.

The telephone counseling and motivational interviews helped guide the participants through each

stage of the TTM, while supporting participants of their commitment to abstinence to prevent

relapse. NRT consisted of supplying participants with nicotine patches during the first week; if

patches were requested within the first week, participants were given six weeks’ worth of

patches at no cost after a two-week follow up call. When the program started, all 79 men

involved in the study were in the contemplation stage, with 14 individuals relapsing after the first

week. Unfortunately, many of the participants either “continued occasional smoking (40%) or

stopped daily smoking two to six days prior to answering the questionnaire in the post-

intervention phase (43.1%)” (Haddad et al., 2017). Although the outcome was not as effective as

the researchers hoped, the program helped reduce the number of overall cigarettes being smoked.

The study concluded NRT was the most effective method in curbing cigarette smoking, and

along with the other components, the program helped reduce and/or quit smoking (Haddad et al.,

2017).

The next study, titled “Media Campaign Effectiveness in Promoting a Smoking-

Cessation Program” (Czarnecki, Vichinsky, Ellis, & Perl, 2010) focused on the impact of a

media campaign on smoking cessation. The study mentions “In the U.S., all states offer phone-

based cessation services; most provide assistance such as self-help materials or counseling,

whereas less than a quarter provide nicotine replacement therapy (NRT)” (Czarnecki et al.,

2010). The study evaluated the effectiveness of a New York City NRT giveaway program,

named the Nicotine Patch Program (NPP). Researchers aimed to gain understanding of

awareness of the program, perceived barriers and reasons of not participating, and suggestions

for better outreach methods. This campaign included TV, radio, and print advertisements in
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English and Spanish. The television campaign featured “testimonials from dying and sick

smokers and graphic images of the physical effects of smoking” (Czarnecki et al., 2010). There

were also “10-second TV ‘bumpers,’ as well as the radio and sports game announcements”

(Czarnecki et al., 2010) all using the tag line “You May Be Eligible for New York City's

Nicotine Patch Program. Limited Supply, Call 311 Now.” Even though this program did not

necessarily aid in quitting smoking, it provided many citizens of New York City information on

where to obtain a nicotine patch. “60% of NYC smokers, representing almost 700,000 New

Yorkers, reported program awareness” (Czarnecki et al., 2010). Although the program was

aimed at reaching smokers who were ready to quit, the rest of the smoker population gained

knowledge of a cessation technique (NRT).

The following intervention utilized over-the-phone counseling to aid in cessation of

tobacco. The study, titled “Telephone-Based Coaching: A Comparison of Tobacco Cessation

Programs in an Integrated Health Care System” (Boccio et al., 2016), involved 241 individuals

who were patients at a Kaiser Permanente in Northern California and two control groups. The

241 individuals participated in tobacco cessation coaching over the phone. The control groups

were “propensity-score–matched controls, and controls who participated in a tobacco cessation

class during the same period” (Boccio et al., 2016). The participants who were involved in the

telephone coaching were given an average of two motivational interviewing-based sessions;

these sessions helped the individual evaluate the reasons for quitting and aided in establishing a

plan to quit (Boccio et al., 2016). The evaluation method for this study was self-reporting of

quitting and refills of medication within 12 months of follow-up to help quit smoking. The

results of the study were promising; the rate of cessation was higher among coaching participants

than matched controls (31% vs. 23%), and was nearly the same when compared to the class
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participants (31% vs. 29%) (Boccio et al., 2016). Telephone participants and class attendees

filled prescriptions to help quit tobacco much more than the controls (47% for both vs. 6%). This

study revealed telephone coaching and in-person classes helped individuals to cease smoking as

opposed to no treatment at all. The study also mentioned how this technique can be applied to

many health care systems looking to decrease smoking among their patients (Boccio et al.,

2016).

The next study was geared toward Alaska Native (AN) adolescents, and is titled

“Development of a tobacco cessation intervention for Alaska Native youth” (Patten et al., 2012).

The researchers used the Social Cognitive Theory (SCT) for the basis of the intervention, and it

involved two pilots. Participants in the first pilot were nine adolescents, all female, and ages 13-

16; participants in the second pilot included 12 adolescents (eight females, four males) aged 12-

17. The study included a teen advisory group who were knowledgeable in short and long-term

risks of tobacco use, communication skills, moderating group discussions, and problem-solving

skills (Patten et al., 2012). Citing the SCT, a group-based intervention was chosen where

adolescents from the same village could quit tobacco use together; cognitive behavioral

counseling was included in sessions to enhance self-efficacy and coping skills (Patten et al.,

2012). The intervention was tailored to AN culture, with the research stating it was “designed to

include talking circles and feature personal stories from AN elders and teen advisors. These

individuals shared their stories of tobacco and how it had affected their family and community

and shared why quitting tobacco is important” (Patten et al., 2012). Lastly, written materials on

tobacco cessation and cessation referrals were given to participants’ parents, which were also

culturally tailored. For the first pilot, the self-reported 7-day and 30-day point prevalence

abstinence rates were 11% (1 of 9) and 0% (0 of 9) (Patten et al., 2012). Since the findings of the
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first pilot were unfortunate, the researchers changed the duration of the program, making it three

days and two evenings; the researchers also included more recreational activities. The change

resulted in a more positive outcome: “the self-reported 7-day and 30-day point prevalence

abstinence rates were 86% (6 of 7) and 71% (5 of 7)” (Patten et al., 2012). This intervention

revealed that using a theoretical framework was beneficial to the participants, with teens

responding well and engaging in intervention activities involving story-telling and talking circles

(Patten et al., 2012). Social support was a main contributor to the success of the intervention.

Lastly, one of the most well-known intervention methods for tobacco cessation is from

the Centers for Disease Control and Prevention (CDC) called Tips From Former Smokers (Tips).

These are television ads which show the detrimental effects of smoking that affect real people.

The CDC (2017) states “The Tips campaign counters these sobering statistics by giving a face of

a real person to the 16 million Americans who are living day in and day out with these

consequences.” After each ad and campaign is aired, there are increases in media traffic and

telephone calls to 1-800-QUIT-NOW, their telephone tobacco cessation hotline. Since 2012, the

CDC (2017) estimates millions have attempted to quit smoking, and half a million have quit

permanently. According to the CDC (2017), “Economic analysis of the Tips campaign has

shown that for every $2,000” spent, a death is prevented. This campaign is proof of how

effective visuals can be in raising the public’s perceived susceptibility and perceived severity.

Intervention Proposal

The health promotion program I would choose to implement is to “reduce cigarette

smoking by adults” (Healthy People 2020, 2018). I would utilize the Health Belief Model

(HBM) to guide my program. The population I would target is adults who are current cigarette

smokers. I would recruit participants through flyers posted in areas where smokers would most
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likely see them, like hospitals, community health centers, and universities. The program would

consist of 150 participants, with half of them receiving education to change their behavior; the

other half will not receive anything on the program’s part. Both groups will take a pre- and post-

test to evaluate effectiveness of the program. Since the program is education based, I would like

it to run over the course of two days. Once participants are enrolled, a pre-test will be given to

measure the baseline knowledge of tobacco harm. This will be the only information given to the

control group. For the experimental group, I will follow the HBM to raise participants’ perceived

susceptibility, perceived severity, and perceived benefits. This can be done by educating them

with facts surrounding the harmful effects of this behavior. The program will consist of lectures,

activities, group discussions, open dialogue, and call-and-response interaction. The hope will be

to lower their perceived barriers, arm them with strategies to quit smoking, and help them

believe they will be able to quit for good. Lastly, post-test will be administered to both groups,

with the results evaluated to see the strength of the program.

A limitation of this program is it is short-term; smoking cigarettes takes more effort than

two days. I foresee many of the participants still engaging in the behavior. Also, in the span of

two days, many participants may not feel as though they are ready to leave cigarettes behind.

Starting a program like this, the educator must know most individuals understand the effects of

smoking and diseases it may cause. This program also does not take into consideration the

environment the participant is around; tobacco culture may surround their everyday life, and the

information obtained in the program is for the individual, not people around them.
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Conclusion

To conclude, tobacco use is one of many health crises the United States is facing. All are

equally important and outcomes need to be improved for the better of society. Many, if not all, of

Healthy People 2020’s topics are decreasing the life span of Americans, and although many are

not preventable, tobacco use is. Health promotion programs are necessary to tackle these issues,

and through these programs knowledge is obtained of areas that need help in a certain behavior

as opposed to other areas where a different behavior is affecting individuals. The number of lives

tobacco has claimed and continues to claim prove there is much work to be done for tobacco

cessation.
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References

Boccio, M., Sanna, R. S., Adams, S. R., Goler, N. C., Brown, S. D., Neugebauer, R. S., . . .

Schmittdiel, J. A. (2016). Telephone-Based Coaching. American Journal of Health

Promotion,31(2), 136-142. doi:10.4278/ajhp.140821-quan-424

Centers for Disease Control and Prevention. (2017). Tips From Former Smokers ®. Retrieved

from https://www.cdc.gov/tobacco/campaign/tips/about/impact/campaign-impact-

results.html

Czarnecki, K. D., Vichinsky, L. E., Ellis, J. A., & Perl, S. B. (2010). Media Campaign

Effectiveness in Promoting a Smoking-Cessation Program. American Journal of

Preventive Medicine,38(3). doi:10.1016/j.amepre.2009.11.019

Haddad, L., Al-Bashaireh, A., Ferrell, A., & Ghadban, R. (2017). Effectiveness of a Culturally-

Tailored Smoking Cessation Intervention for Arab-American Men. International Journal

of Environmental Research and Public Health,14(4), 411. doi:10.3390/ijerph14040411

Healthy People 2020. (2018). Tobacco Use. Retrieved from

https://www.healthypeople.gov/2020/topics-objectives/topic/tobacco-use

Patten, C. A., Fadahunsi, O., Hanza, M., Smith, C. M., Hughes, C. A., Brockman, T. A., . . .

Offord, K. P. (2012). Development of a tobacco cessation intervention for Alaska Native

youth. Addiction Research & Theory,21(4), 273-284.

doi:10.3109/16066359.2012.714428

World Health Organization. (2018). Tobacco. Retrieved from

http://www.who.int/mediacentre/factsheets/fs339/en/