1. 2008 Johns Hopkins Bloomberg School of Public Health Setting Up a Smoking Cessation Clinic Sophia Chan PhD, MPH, RN, RSCN Department of Nursing Studies The University of Hong Kong

2. 2008 Johns Hopkins Bloomberg School of Public Health 2 Learning Objectives To determine the vision, mission, and target population of the smoking cessation clinic To introduce the structure, process, and outcomes of setting up a smoking cessation clinic To discuss the preparation of hardware and software for setting up the clinic

3. 2008 Johns Hopkins Bloomberg School of Public Health 3 Learning Objectives To identify program models and components of the clinic To discuss the evaluation of outcomes To examine system change strategies in setting up smoking cessation services

4. 2008 Johns Hopkins Bloomberg School of Public Health 4 Vision and Mission High-quality service Compassionate patient care Providing the best treatment Enhancing quality of life Integration of education, research, and clinical practice

5. 2008 Johns Hopkins Bloomberg School of Public Health 5 Target Population General public Hospitalized patients Outpatients Physician-referred Self-referred

6. 2008 Johns Hopkins Bloomberg School of Public Health 6 Program Design Adoption of evidence-based clinical practice guidelines (Fiore et al., 2000) Routine identification of tobacco use Integration into regular provision of care Trained smoking cessation counselorskey to service delivery Models of counseling Evaluation of success

7. 2008 Johns Hopkins Bloomberg School of Public Health 7 The Structure: Hardware Hardware The clinic site: hospital, outpatient clinics, community centers Opening hours: office hours, evenings Mode of intervention: face-to-face, telephone, Web-based Resources: staff, budget, equipment, publicity, pharmacotherapy

8. 2008 Johns Hopkins Bloomberg School of Public Health 8 The Process: Software Software Staffing: smoking cessation counselors, administrators, research staff Training: basic, advance, assessments Quality assurance system: case conferences, evaluation, continuing education Follow-up: frequency, measurements

9. 2008 Johns Hopkins Bloomberg School of Public Health 9 Promotion and Publicity of the Clinic

10. 2008 Johns Hopkins Bloomberg School of Public Health 10 Training and Preparation of Counselors

11. 2008 Johns Hopkins Bloomberg School of Public Health 11 The Smoking Cessation Counselor: Responsibilities Establish rapport with smoker Assess smoking history, nicotine dependence, and readiness to quit Develop a clinical impression and prepare a quit plan Provide counseling, health education, and relevant advice to the smoker Maintain clear and accurate records Arrange follow-up

12. 2008 Johns Hopkins Bloomberg School of Public Health 12 Treatment Components Alliance with smoker, develop helping relationship Individualized, group, telephone counseling Health education materials, Web site Addiction philosophy and approaches (e.g., Fagerstrom test) Stage-matched interventions

13. 2008 Johns Hopkins Bloomberg School of Public Health 13 Health Education Materials

14. 2008 Johns Hopkins Bloomberg School of Public Health 14 Quitline

15. 2008 Johns Hopkins Bloomberg School of Public Health 15 Program Models: 5As and 5Rs Ask: identify tobacco use at every visit Advise: provide appropriate advice (individual vs. group) Assess: stage of readiness to change Assist: offer stage-matched interventions or motivational intervention (5Rs) Arrange: follow-up and relapse prevention or re-engagement

16. 2008 Johns Hopkins Bloomberg School of Public Health 16 Program Model: 5Rs Relevance Risks Reward Road blocks Repetition

17. 2008 Johns Hopkins Bloomberg School of Public Health 17 The Cycle of Stopping Smoking

18. 2008 Johns Hopkins Bloomberg School of Public Health 18 Source: Prochaska and DiClemente. Transtheoretical Model of Change Pre-contemplation: not ready to change Contemplation: thinking about change Preparation: getting ready to make change Action: making the change Maintenance: sustaining behavior change until integrated into lifestyle

19. 2008 Johns Hopkins Bloomberg School of Public Health 19 Program Models: AWARD Ask Warn Assess Refer Do it again

20. 2008 Johns Hopkins Bloomberg School of Public Health 20 Sample Quit Plan Assessment of nicotine dependence (e.g., using the Fagerstrom test) and readiness to quit Quit date Physical addiction withdrawal management plan

21. 2008 Johns Hopkins Bloomberg School of Public Health 21 Sample Quit Plan Psychological and behavioral management plan Social and emotional management plan Follow-up and relapse prevention plan

22. 2008 Johns Hopkins Bloomberg School of Public Health 22 Smoker Makes Appointment to See a Counselor

23. 2008 Johns Hopkins Bloomberg School of Public Health 23 Health Assessment of Smoker

24. 2008 Johns Hopkins Bloomberg School of Public Health 24 Carbon Monoxide (CO) Monitoring

25. 2008 Johns Hopkins Bloomberg School of Public Health 25 Individual Counseling

26. 2008 Johns Hopkins Bloomberg School of Public Health 26 Group Counseling

27. 2008 Johns Hopkins Bloomberg School of Public Health 27 Telephone Counseling

28. 2008 Johns Hopkins Bloomberg School of Public Health 28 Evaluation of Outcomes Structure: site, equipment, staffing Process: recruitment, fidelity of counseling intervention, cost- effectiveness Outcomes: quit rate, quit attempts, smoking reduction, change of stage Biochemical-validated outcomes: urine or saliva cotinine

29. 2008 Johns Hopkins Bloomberg School of Public Health 29 System Change Strategies Implement a tobacco user identification system in the health care setting Promote clinic services through mass media and other communication channels Provide education, resources, and feedback to promote the clinic service

30. 2008 Johns Hopkins Bloomberg School of Public Health 30 System Change Strategies Dedicate staff to provide smoking cessation intervention and assess performance Include smoking cessation treatments (counseling and pharmacotherapy) in health plans and health insurance Reimburse clinicians for delivering smoking cessation treatments and include cessation treatment as part of their job duties

31. 2008 Johns Hopkins Bloomberg School of Public Health 31 Help Your Clients Quit Smoking TODAY!