Smoking Cessation

1

SMOKING CESSATION EVALUATION

SMOKING CESSATION EVALUATION 21

Running head: Smoking Cessation Evaluation

Smoking Cessation Intervention: Evaluation literature review

Karen L. Lukaszewicz

University of South Florida

College of Public Health

In partial fulfillment of the requirements for MHS 7740

Roger Boothroyd, Ph.D.

April 20, 2014

Abstract

Objectives: To Evaluate the effectiveness of community policy program and public health prevention initiatives to assist in smoking cessation.

Background: Smoking is the direct cause of avoidable diseases worldwide. Smoking cessation can be treated in various phases. These phases are preparation, intervention and maintenance by participating in community policy programs and public health initiatives. To identify level of community organization and readiness to implement tobacco control programs in order to facilitate future training and technical assistance.

Methods: Community health clinics and the assistance of community intervention policy programs

Key words: Smoking cessation, programs, and evaluation

Background Information

Smoking is addictive and tobacco contains a substance known as Nicotine, which is highly addictive. Nicotine dependence can lead to serious health problems, which are smoking related diseases. Cigarette smoking is regarded as the top cause of preventable disease and death worldwide. Average statistics indicate that at least five individuals in the United States die each year from smoking. Smoking cessation is the process of discontinuing tobacco smoking with the assistance of health care professions such as physician or clinical officers. It is advisable to get support from doctors, nurses, therapist or a friend to help you focus and relapse. To avoid smoking triggers you can also consult your state health department or smoking programs such as American Lung Association freedom from smoking program. An estimated 20.9% of adults smoke cigarettes but is more common in men than women. In the 1950s, fewer than 50% of American adults believed that cigarette smoking caused lung cancer. In 1986, this proportion had increased to 92%. According to the American Lung Association smoking is the leading cause of increased risk for diseases causes of death from cigarette smoke includes stroke, lung cancer, coronary heart disease, chronic lung disease. In 2011, an estimated 19 percent of U.S. adults were cigarette smokers. People who smoke increased by up to six times and are more likely to suffer from a heart attack than nonsmokers. Comment by karen lukaszewicz: Only 5 Comment by karen lukaszewicz: Do you have a citation? Comment by karen lukaszewicz: source

Literature Review

According to Morbidity and mortality Report (2002) secondhand smoke is harmful to health of children and unborn children causing ailments that will eventually lead to death. Research done by the CDC (Center for Disease Control) estimates that there are more former smokers than current smokers which indicates that although it is an addictive habit quitting is not that difficult. According to Fiore et al. (1990) US Survey conducted in 1986, found that 95% of smokers (former) had quit for 1-10 years and still had difficulty in actually stopping. Nicotine is highly addictive and the withdrawal symptoms are what make it difficult to quit. The withdrawal symptoms are common in most smokers who try to quit, symptoms such as, irritability, anxiety, increased appetite, difficulty concentrating and constant craving for cigarette. Comment by karen lukaszewicz: source?

Among U.S. smokers 68.8% have been reported by the CDC as wanting to quit the norm and this has indicated that more adults are willing to quit than younger men. In 2012, the American Lung Association did a report about “Helping Smokers quit” and they estimated that the number of former smokers has exceeded the number of current smokers. They approximated most quitters used self-help quitting strategies and estimated that fewer smokers use smoking cessation clinics. Heavy smokers require the clinics more urgently because they have been smoking for a longer period. In the study we will be looking at effectiveness and efficiency of Texas Department of State Health services on assisting in smoking cessation. Comment by karen lukaszewicz: Is that the word you meant

Youth implications

Congress implemented a law in 1992 that included an amendment aimed at decreasing access to tobacco products to under aged individuals (under the age of 18). This was an eyebrow raiser after it was estimated by the SDC that 26.8% of smokers under the age of 18 are not only smoking tobacco, but also other products. They also concluded that 36.5% are adult smokers with the intention to quit but due to withdrawal symptoms they cannot. It is estimated that 68.8% want to quit and seek medical assistance and counseling from psychiatrists and clinicians to stop the norm. The amendment was mainly introduced to reduce the number of minor smokers. Comment by karen lukaszewicz: What law Comment by karen lukaszewicz: What is SDC Comment by karen lukaszewicz: Where does this statistic come from Comment by karen lukaszewicz: What is the norm?

There are various methods of smoking cessation treatments that have been proven and others are just hypothesis which have not been tested. According to Rubin et al. (1989) there are phases that are followed in the treatment of smoking cessation. The 5 stages of Tran-theoretical model, which include pre contemplation where patients feel that negatives of smoking, may not outweigh the positive. Contemplation is the following stage where a patient re-evaluates smoking behavior and considers change. Preparation is all in the mindset of individuals who are willing to cooperate with health clinics and community based intervention to assist in smoking cessation. Action is the stage a patient makes major lifestyle changes to adapt the non-smoking period and the maintenance stage to stay smoke free for 6 months.

The Texas medical association has given hopes to the resident of Texas in collaboration with the American Medical Association (AMA) they have developed Health Life Steps Program to patients. Cessation programs have been regarded as the best formulae to help smokers quit smoking. In 2005 it was established that a small increase in quit rates was identified when individuals used self-help groups. Programs that include multiple treatments are more successful than single interventions. There are usually helpful resources such as free telephone support services that can help individuals to stop smoking through free support advice, referral to other resources, free or discounted medications and latest information of medications.

The CDC showed that the reason majority of the citizens continue smoking is because cessation programs are not easy to access. They suggested that prior authorization requirements, therapy and records on how many times a patient can be treated are among the best ways to reduce the rate of smokers. The U.S healthcare system has covered part of its budget for programs such as smoking cessation. Community interventions delivered by the healthcare system are useful in cessation and counseling has been identified as the best alternative as the patient is active around others with similar problems.

A US Survey has shown that 10.2 % quit rate has been due to physician advice and this has led to increase in abstinence rates. Smokers should also be shown or advised on the implications to their health especially through frequent checkups. Single medication can also be a preventative role as through the Trans-theoretical model which indicates that through change quitting is easier. The America Cancer Society has estimated that 25% of the citizens can stay smoke free for a period of six months. The FDA (Food and Drug Administration) has approved the use of Nicotine replacement therapy, which has a 50% to 70% in helping smokers stop. It has been observed by 2008 US Guidelines that most people prefer using long-term nicotine patches and nicotine inhalers because it is user friendly and cheaper. Comment by karen lukaszewicz: Do you know what survey Comment by karen lukaszewicz: Increase/decrease? Comment by karen lukaszewicz: Which guidelines

Taxation is a means that can help in preventing smokers from engaging in the activity. Through community intervention the state can implement a law that increases the price of cigarettes. Denying individuals the right to smoke openly can reduce the amount of smokers. The mass media campaigns has been the most effective cessation method as these campaigns were engineered in the US cities in 2007 and 2006 are aimed at encouraging adult smokers to quit. The National Alliance for Tobacco Cessation target audience was defined to smokers open to quitting but cannot successfully quit. Cigarette smoking causes many diseases and affects every organ of the body. 17,800 Texans died from tobacco-related cancers, including acute myeloid leukemia and cancers of the lung, oral cavity and pharynx, esophagus, bladder, pancreas, kidney, cervix and stomach. Every year more than 24,100 Texans die from a smoking-related illness such as cancer or cardiovascular and respiratory disease. Tobacco use is responsible for a wide range of other health conditions. The number one cause of cancer deaths among Texas men and women is lung cancer that is more than 90% of lung cancers in men. Comment by karen lukaszewicz: Do you know what cities Comment by karen lukaszewicz: Change sentence not to start with a sentence Comment by karen lukaszewicz: I need regferences for these numbers

A 2006 report estimated that Texas could achieve significant cost savings by funding comprehensive tobacco prevention and control programs at levels recommended by state researchers. Effective community-based tobacco-control programs, such as the National Cancer Institute's (NCI) Community Intervention Trial for Smoking Cessation and NCI and the American Cancer Society's American Stop Smoking Intervention Study, stimulate community involvement by identifying major community groups and organizations that can support interventions. Smoking-control activities in communities should encompass health-care providers, worksites, cessation resources and services, and public education. The study concluded that a comprehensive tobacco prevention and control program would achieve return on investment over a five-year period. Savings would accumulate over time. Nonsmokers would stay healthy, and smokers who quit would be healthier, preventing costly medical care and productivity losses. Comment by karen lukaszewicz: What 2006 report

According to American Lung Association statistics Texas can save a lot of money if they implement proper and managed smoking cessation treatments. This chart below shows how much the federal government can save if state of Texas could implement the treatment programs.

	Annual cost to state
Direct Health Care Expenditure	$17,688,432
Workplace Productivity losses.	$29,915,818
Total Average Potential Annual savings	$47,604,250

Description of the service

The Study was conducted in Texas in 8 East Texas Communities to study the effectiveness of tobacco preventions and cessation programs. As a part of the research the 76 legislatures appropriated from the Endowment that promoted cessation and helped minimized use of tobacco. It is estimated that in the year 2005, 27,000 Texans had tobacco related diseases and the number one cause of cancer was lung cancer. The Texan and Tobacco report (2003) report indicated that approximately 25% of the adult population in Texas smokes. This created the need to study the best method to use to help assist smokers quit. The coalition measures what has been done and the effects it has had on the community. Evaluation findings tell us how programs, policies or practices might be improved to achieve better outcomes Comment by karen lukaszewicz: The American ling association study Comment by karen lukaszewicz: What endowment Comment by karen lukaszewicz: Source

Research procedure and Timeline Comment by karen lukaszewicz: For what? Stage One Training and support for Logic Modeling process Organize training workshop for project staff to introduce evaluation proposal and Logic Modeling concept Preparation for data collection Develop draft interview schedules for Phase Two Formative feedback Prepare and submit final version of Phase One report Stage Two Training and Support for Logic Modeling process Meet project staff to review ongoing relevance and validity of their project Logic Models Preparation for data collection Set up database for routine and project monitoring data Refine and agree final interview schedules Data collection Planning ,implementation and evaluation

Stage one

The main focus was to evaluate the objectives. Among the 8 East Texas communities the evaluation was done in schools and community Youth programs that were initiated in various communities. The objective was to encourage tobacco control programs to facilitate future training and technical assistance. The target population will be mainly customers both individual and corporate members of the community. The target population will be Texan region dwellers that included schools. Healthcare providers and youth leaders in the communities. Comment by karen lukaszewicz: Do we tyepe 8 or eight Comment by karen lukaszewicz: Is you th capitalized, do we know what youth program

Research has indicated that most people are not ready to go to action right away. The Trans-theoretical model is a best model to use in an area like Texas since evaluation of the techniques have not been fully implemented. The officials or non involvement are in the pre-contemplation stage as they are reluctant to change. There also people are working for change (maintenance) others who are thinking of change, adults (contemplation). There are those in the preparation stage and others in the Action stage. This model illustrates how the population perceives the take on smoking cessation and how it can be eradicated. Through emphasis from regulations, program, interventions and state based regulations the morbidity mortality rate can be reduced. Patients learn to seek support from talk with people they trust, spend time with people who behave in healthy ways and remember to engage in alternative actions to cope with stress of unhealthy behavior. Comment by karen lukaszewicz: Non involvement what?

Youth prevention was viewed as the highest priority in all communities. There has been a significant rise in the communities’ youth adults who partake in smoking. Through advertisements they are exposed and this increase desire to smoke. Study was done and around 35% of the young population think it’s cool to smoke.50.8% have been smoking or actually tried smoking in the past 12 months. The youth were against the proposals to enact some laws to control tobacco use. Tobacco regulations require providing information relating to Substance Abuse by youth and indicate youth tobacco access rate (Annual Synar Report). In general prevention programs were not noted to be adequate and only 3 out of 5 communities had some type of tobacco control measure. There was also no involvement of city council officials, business leaders, ethnic group leaders and media leaders in assisting the community in general. It is estimated that Tobacco related diseases cost the state $10 billion. This would have been prevented if there were involvement of local community’s leaders in funding comprehensively control programs. This would be cost effective and enable the state citizens to live healthier and prevent productivity losses. Comment by karen lukaszewicz: What study Comment by karen lukaszewicz: source Comment by karen lukaszewicz: reword Comment by karen lukaszewicz: should it be three and five or 3 and 5 Comment by karen lukaszewicz: There also was not any involvement Comment by karen lukaszewicz: Where did this statistic come from Comment by karen lukaszewicz: What would be cost effective

Although it is estimated that most smokers quit without using evidence based systems the Texans communities have developed brief programs that assist in reduction of smoke related illnesses. Brief clinical interventions in community based pharmacist or workshop programs as above stated assist to prepare the patient mentally in quitting smoking. It is approximated that 3.3 million adults will try to quit this year but this cannot be achieved overnight without assistance. The coordination of healthcare administrators, insurers and purchasers practitioners can boost cessation success. Despite such facts the response by both clinicians and Texas Healthcare system has been lacking. Comment by karen lukaszewicz: Quit smoking? Comment by karen lukaszewicz: What evidence based programs are there Comment by karen lukaszewicz: Like what Comment by karen lukaszewicz: Unclear sentence Comment by karen lukaszewicz: Where did this number come from Comment by karen lukaszewicz: How?

Evaluating health interventions and Outcomes

The University of Houston developed a Texas smoke free ordinance database that analyzes different variables related to smoking in Texas. The research has enable individuals to get information about cessation programs available. The primary outcome was smoking status in different communities and identifying organization and readiness to implement tobacco control programs in order to facilitate future training and technical assistance. There has been significant decrease in illegal sales of tobacco from 56% to retail violation rate of 7%. Programs such as state and community interventions that include community based supporting activities to influence the coming generation of youthful leaders. Health communications strategies should be implemented to discourage cigarette smoking. Quit line counseling should also be encouraged and developed to be available to tobacco users. Message should focus on high-risk areas. Individual, group, or telephone counseling programs as stated above are highly acknowledged in the region. Comment by karen lukaszewicz: Has enabled? Comment by karen lukaszewicz: Such as? Comment by karen lukaszewicz: Unclear and needs source

Health care professionals have been introduced to influence quitting by adolescent smokers. They also educate children about dangers of smoking but it is statistically proven that 80% of smokers begin before the age of 18. The research has indicated that pharmacists do not do routine evaluation of smoking cessation related activities or document cessation patient information and outcomes. Development of Electrical Health Records which are inclusive identification can assist patients interested in smoking cessation resources through Quit Work programs. This kind of system was implemented in Massachusetts Control program in 2002 and has assisted patients to quit smoking across the state. Comment by karen lukaszewicz: This says adolescent smokers educated health care professionals Comment by karen lukaszewicz: Where did this come from Comment by karen lukaszewicz: What research, nothing ahs been cited Comment by karen lukaszewicz: Pharmacists do this? Comment by karen lukaszewicz: Sentence unclear Comment by karen lukaszewicz: Electrical or electronic? Comment by karen lukaszewicz: How did this type of system assist in quitting smoking

Government funding was increased to assist regional smoking cessation services. The main aim of this was improve access to services and reducing smoking rates. Studies have shown that men incur more in lifetime medical expenses than men and women who do not smoke. Smoking cessation programs, typically aim to positively change a health behavior, which in turn, is deter-mined by a diverse range of individual and environmental factors. Moreover, such interventions set out to achieve positive outcomes in ever changing social, organizational, economic and political contexts these types of interventions are not easily evaluated by traditional experimental designs. Comment by karen lukaszewicz: What kind of funding, from where, by how much Comment by karen lukaszewicz: unclear Comment by karen lukaszewicz: what studies

Health researchers are increasingly urged to use evaluation designs which not only capture outcomes but which also elucidates implementation processes, and contextual factors that may influence the success of an intervention. The study helps to asess changes in the average number of programs used in Texas to help eradicate smoking. It asess time most individuals take to help the community at large in smoking cessation. Evaluation is used to assess the implementation and outcomes of a program, increase efficiency and impact over time, and demonstrate accountability. A comprehensive state tobacco prevention and control plan, with well-defined goals, objectives, and short-term, intermediate and long-term indicators, requires appropriate surveillance and evaluation data systems. Program results are measured by comparing baseline data for each objective and performance indicator to similar data at a later point in time. Surveillance and evaluation systems must have high priority in the planning process Comment by karen lukaszewicz: what kind of evaluation designs Comment by karen lukaszewicz: unclear Comment by karen lukaszewicz: wher e does the baseline data come from, your evaluation? Or previous evaluation

Data Collection

The sample will employ a descriptive design to gather information on smoking cessation programs in Texas. A descriptive survey is a process of collecting data from the members of a population in order to determine the current status of the subjects under study with respect to one or more variables (Frankel and Wallen, 2000). It is intended for gathering information and data for identifying standards against which conditions will be compared or to determine the relationship that exists between specific events. Data include tobacco use and lung cancer rates by various groups in the community, compliance with retailer and youth tobacco access laws, as well as secondhand smoke policies in schools, worksites, restaurants, bars and other public places Comment by karen lukaszewicz: Is this the end of the sentence

The study investigates the extent of use of cessation programs such as effective policing program; outcomes associated with an evidence behavioral health intervention and impact of health prevention initiatives. Descriptive design will be used since it gives the description of the phenomenon: In descriptive statistics, the researcher has no control on the variables, she can only report what she observes and what happened or what is happening and he seeks to measure items such as frequency, people’s preferences or similar data (Kothari, 2003). The researcher will also use descriptive survey since it has been used in similar studies. The research will approach the patient both individual and community and those involved in the initiative to help individuals in smoking cessation. Comment by karen lukaszewicz: What study

Assessment Evaluators collect and review data from many sources to define the community’s tobacco-related problems, resources already in place to address them and additional resources that are needed. The sequence of actions in the assessment phase includes, collecting data to identify the problem of local tobacco use and tobacco-related health consequences, identifying local resources to address the problems, analyzing the data, prioritizing tobacco-related problems and their causes, and sharing the data (DIANE Publishing Company, 1990). Implementation this stage involves putting the plan into action with evidence-based strategies that were identified in the planning stage. It also means documenting and measuring how the plan is carried out and how well it works, making course corrections as needed and finalizing the evaluation plan. The basic elements of this step include, carrying out planned services, documenting what is done and evaluating the implementation process. Comment by karen lukaszewicz: What is them? The problems, programs? Comment by karen lukaszewicz: Is this citation correct Comment by karen lukaszewicz: Doesn’t make sense

The process of involving key stakeholders was conducted using Transtheoretical model and theory of change. Engaging stakeholders, developing and delivering, and those intended to benefit from interventions aimed at them, in their evaluation design, are considered by many to increase the validity and rigor of the subsequent evidence generated. This study is intended to determine not only the components and processes, but also the possible effectiveness of this set of health interventions, and contribute to the evidence base about smoking cessation interventions aimed at priority groups in Texas. It is also anticipated that this study will contribute to the ongoing debate about the role and challenges of realist Evaluation approaches in general. Comment by karen lukaszewicz: Involving key stakeholders for what? Comment by karen lukaszewicz: What study Comment by karen lukaszewicz: How?

Conclusion

Many people can quit smoking, but staying off cigarettes requires maintenance, support, and additional techniques, such as relapse prevention. Clinicians also play an important role in providing nicotine replacement products such as nicotine gum or trans-dermal patches. Physicians, dentists, and other health professionals can provide important assistance to their patients who smoke. Quit rates can be improved if clinicians provide more help through counseling, support than just simple advice and warnings. These products are particularly useful for smokers who show evidence of strong physiologic addiction to nicotine (DIANE Publishing Company, 1990). Comment by karen lukaszewicz: Sounds like middle school Comment by karen lukaszewicz: What kind of assistance

Attitudes toward smoking have shifted dramatically. A majority of the public favors policies restricting smoking in public places and worksites. Half of all Americans who ever smoked had stopped smoking by 1988. Of those who continue to smoke, more than 70% report that they would like to quit. By increasing their knowledge about smoking-cessation methods, health professionals can support and encourage the large majority of smokers who want to quit. State action on tobacco use treatment should include the following elements; establishing population based counseling and treatment programs such as cessation help lines. Making the system changes recommended by sponsored cessation guidelines, covering treatment for tobacco use under both public and private insurance and Eliminating cost barriers to treatment for underserved populations particularly the uninsured Comment by karen lukaszewicz: citation Comment by karen lukaszewicz: source Comment by karen lukaszewicz: that is it, shouldn’t you list at least two Comment by karen lukaszewicz: how are you going to eliminate cost barriers Comment by karen lukaszewicz: is this the end?

Reference

Ogden J. (2012) Health psychology: A textbook. (5 ed., pp. 88-100). New York: McGraw-Hill International

DIANE Publishing Company. (1990). Health benefits of smoking cessation: A report of the surgeon general. (pp. 6-25). Maryland: DIANE Publishing.

CDC. Cigarette smoking among adults-.United States, 1990.MMWR; 41:354-5, 361-62

Centers for Disease Control and Prevention Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses—United States, 2000–2004. Morbidity and Mortality Weekly Report 2008; 57(45):1226–8. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a3.htm accessed Mar. 11, 2011.

Cummings SR, Rubin SM, Oster G. The cost-effectiveness of counseling smokers to quit; 261:75-9 JAMA 1989

Elixhauser A. The costs of smoking and the cost effectiveness of smoking-cessation programs’ Public Health Policy 1990; 11:218-37

None of these seem to refer to the Texas smoking cessation you are talking about.

The references also need to be in alphabetical order and I don’t think they are in APA format