WWW Iowa Healthcare Collaborative

Tobacco Cessation


Case for Change

The use of tobacco is the leading cause of death in the United States and has been linked to cancer, cardiovascular disease, respiratory disease, and various other diseases. In the state of Iowa, almost 20% of the population uses tobacco products1 and 14.5% of them use every day2. In 2006 the state of Iowa spent $794 million on tobacco related illness and treatment3. Additionally, 7.5 million packs of cigarettes were sold to underage children, drawing in 4,700 new youth addicts per year3. The Iowa Department of Public Health states that 75% of current tobacco users would like to completely quit but only 18% of those plan to quit within the next 30 days4.

Iowa's physicians must become tobacco cessation leaders and change this growing addiction pattern. Physicians are in a position to help prevent the use of tobacco and help those addicted quit for good. The Iowa Healthcare Collaborative has developed this toolkit to equip Iowa physicians in preventing, treating, and helping patients with tobacco addictions.

This toolkit will:
  • Use evidence based clinical guidelines to increase patient health
  • Increase provider education
  • Provide patient tools and educational materials
  • Provide community tools and programs
  • Provide information regarding tobacco legislation
Sources:
  1. CDC. (2007). BRFSS Data.
  2. CDC. (2007). BRFSS Data.
  3. CDC. (2006).
  4. Iowa Department of Public Health. (2006). Iowa 2006 Adult Tobacco Use Survey: Executive Summary.


Tool Kit

Evidence Based Clinical Guidelines

General Tobacco Cessation

Adult Guidelines
Youth Guidelines
  • Journal of Pediatrics
    This article describes the state of office-based interventions for youth tobacco use, including information on current clinical practice guidelines.

  • National Guideline Clearinghouse
    Guideline for tobacco use prevention and cessation for infants, children, and adolescents.



Educational Materials

Provider Education


Patient Education

Educational Information Tools
  • Iowa Department of Public Health
    The following resources from the Iowa Department of Public Health can help your patients when they decide to quit tobacco.
    • 5 Day Quit Plan
      This document helps you create an action plan and lists things to consider when quitting smoking.

    • Tips for Week 1 - Cravings
      This document lists techniques to help you successfully deal with the nicotine cravings associated with quitting smoking.

    • Weight Control While Quitting
      This document gives tips on avoiding weight gain as you quit.

  • Self-Help Websites
    • American Lung Association - Freedom from Smoking
      Free online smoking cessation program.

    • Become An Ex
      This site is free to anyone looking for help with tobacco cessation, and utilizes proven methods to teach smokers how to quit and how to stay quit.

    • Quit Net
      This site is dedicated to providing comprehensive resources and support for people trying to give up smoking.



Community Awareness

Community awareness surrounding tobacco use is one of the most important factors in decreasing the overall population use of tobacco. One's environment often determines whether tobacco use occurs, and healthy, supportive communities decrease the tobacco risk factor. The information provided below contains ways to improve community services and successful programs in the state of Iowa, and can be used to increase public awareness of the harm of tobacco products.

Successful Iowa Programs
  • Iowa Tobacco Prevention Alliance
    The Iowa Tobacco Prevention Alliance is the only statewide non-profit organization in Iowa solely dedicated to reducing tobacco use and exposure to second hand smoke. This website provides the components of a comprehensive tobacco control program as recommended by the Centers for Disease Control and Prevention.

  • Guide to Community Preventive Services
    This site provides evidence-based recommendations for programs and policies to promote population health.

  • Quitline Iowa
    Quitline Iowa is a toll-free, statewide smoking cessation telephone counseling hotline where trained counselors provide callers assistance in making an individualized quit plan and on-going support through optional follow-up calls. This is a free service through the Iowa Department of Public Health.

  • Tar Wars
    A tobacco-free education program for kids from the American Academy of Family Physicians. Tar Wars programs are available in a variety of Iowa towns, including Iowa City and Cedar Rapids.



Current Legislation

Provided below are articles concerning recent state or federal legislation that affects the use of tobacco. Understanding the implementation of legislative directives is useful in explaining the reasoning behind current laws.
  • Iowa Department of Human Services
    This letter from the Iowa Medicaid Enterprise informs providers and other interested parties of the changes associated with coverage of smoking cessation drugs by Iowa Medicaid Enterprise to allow IowaCare members to receive the smoking cessation drugs at any pharmacy location.

  • Iowa Department of Public Health
    The Iowa Smoke Free Air Act was signed into law by Governor Chet Culver on April 15, 2008, which regulates smoking in public places, places of employment, and certain outdoor areas.

  • Tobacco Free Kids
    Since the November 1998 multi-state tobacco settlement, the Campaign for Tobacco-Free Kids, American Heart Association, American Lung Association and American Cancer Society Cancer Action Network has issued regular reports assessing whether the states are keeping their promise to use a significant portion of their settlement funds - expected to total $246 billion over the first 25 years-to attack the enormous public health problem posed by tobacco use in the United States. The latest report is titled, "A Broken Promise to Our Children: the 1998 State Tobacco Settlement Nine Years Later."




Success Stories

Iowa Nebraska Primary Care Association

Tobacco Cessation at Community Health Centers - The Iowa Department of Public Health and the Iowa/Nebraska Primary Care Association

In 2007 the Iowa Department of Public Health partnered with the Iowa Nebraska Primary Care Association to provide tobacco cessation services to low income users whose source of care is one of Iowa's twelve Community Health Centers. Data suggests that people with less education, a lower income, and a minority status are more likely to be tobacco users. Community Health Centers in Iowa see a large portion of these populations; therefore, the newly created partnership provides a distinct opportunity for the state's investment in tobacco cessation to be directed where care is needed most and the biggest change can be realized.

Participants enrolled in the program are eligible for 12 weeks of both of the following clinical components: Counseling which includes one of the following:
  • Individual cessation interventions
  • Group cessation interventions
  • Referral to Quitline Iowa
Pharmacotherapy treatment which includes one of the following:
  • Bupropion
  • Chantix (participants can receive up to 24 weeks of counseling and Chantix in certain circumstances)
  • Nicotine Gum
  • Nicotine Patch
Research has suggested receiving both counseling and pharmacotherapy yields the highest rates of successful cessation. Therefore, this program requires that patients receive both components. With the tobacco cessation program available at Community Health Centers throughout Iowa, the potential exists to positively impact thousands of people's lives by helping them break a powerful addiction and by protecting the health of their friends, family, and community.

Though only a few months old, the program has been successful. Below are a few success stories of real participants in the program. A formal evaluation is being conducted by the University of Northern Iowa.
  • A diabetic/hypertensive patient entered the tobacco cessation program on January 23, 2008 and accepted nicotine patches. The patient quit smoking at the end of March. On April 16th she declined patches and is currently still not smoking and is not having to use her inhaler.

  • A 50 year old woman who has been successful in the tobacco cessation program smoked 1 ½ packs of cigarettes per day for 30 years. She has completely quit smoking and would like to say that the program is fantastic and she would recommend it to anyone.

  • After two quit attempts on their own, one patient eventually enrolled into the smoking program. He has been in the program since April and is now only smoking 1 cigarette per day. The patient was smoking up to 2 packs each day and was experiencing some health complications, as well. He stated that the counseling has helped control his triggers and hopes to become smoke-free.
Submitted by: Bery Engebretsen, M.D. Medical Director, Primary Health Care, Inc.



Iowa Department of Public Health

The following Quitline Success Stories have been collected by Quitline Iowa staff.

Quitline Iowa
--June 4, 2008 Edition--

PATIENT 393106 - CLINTON, IA 52732
Smoked pipe tobacco for over 30 years and he decided this year that it was time to quit. Now he's been quit for close to 18 weeks and said he is very grateful that he called Quitline Iowa. He feels that Quitline Iowa was instrumental in his success and knows he will not go back to smoking. He feels better and is glad he does not always have to have air filters running in his house.

PATIENT 392658 - TROY MILLS, IA 52344
After numerous accounts of his 10 year old son telling him he smelt like an ashtray and seeing his own father have three heart attacks and continue smoking, this participant found the motivation to quit. At 4 months smoke-free, he says he is breathing so much better and is enjoying a new car that he purchased. His son is happy for him and asked if he could have the car when he turns 16-his father said 'no' of course.

PATIENT 409103 - PELLA, IA 50219
Started Chantix in March 2008 and then quit smoking on 3/9/08. She's really keeping track and said that she was 64 days quit on this last call. She called us especially to get set up with the coaching calls and feels that the combination of Chantix and coaching has really helped her to achieve the success that she's now enjoying.

- Quitline Iowa -
--May 5, 2008 Edition--

PATIENT 410574 - TRURO, IA 50257
Quit smoking on 3/30, and states that a lot more is getting done around the house with all the energy he is now feeling from not smoking. Has experienced a few slips after meals while being around other smokers, but has decided he needs to stay away from other smokers for a while until he is more comfortable getting past cravings.

PATIENT 396122 - SIOUX CITY, IA 51104
Called in early January to receive the patches though chose to quit without the coaching calls. Today we received a call back from her as she wanted to let us know that she's been quit for 2 months now and she's still very grateful that this program exists for herself and others. She says she also gave the Iowa Quitline phone number to a friend whose 21-year-old grandson wants to quit. During our call, we did discuss relapse prevention, though she seems to be doing very well.

PATIENT 397860 - DES MOINES, IA 50311
Received compliments from his grandchildren for watching their games without smoking. Now he's been quit for 4 months with the support of Quitline Iowa and the patches. Said that he's feeling great and that he's sleeping better.




Mentors

This tool kit was developed in collaboration with the Iowa Department of Public health. IHC would like to thank those individuals and organizations who have shared their materials and who have agreed to serve as mentors, including the Iowans for Wellness and Prevention, the Iowa Department of Public Health, and the Iowa Nebraska Primary Care Association. Please contact IHC if your organization would like to contribute materials to this tool kit.


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