According to the Centers for Disease Control and Prevention, tobacco use remains the leading preventable cause of death in the United States, causing more than 440,000 deaths each year and costing $75 billion a year in direct medical costs. The Rockland County Department of Health created the “Put It Out Rockland” adult smoking cessation program to help motivated smokers quit. According to a May 2003 random-digit dial telephone survey, approximately 15.4 percent of Rockland County adults smoke. Many Rockland smokers want to quit. In fact, the survey found that 70 percent of smokers are “thinking of quitting” and 46 percent of smokers have made at least one serious attempt in the past year. To meet these smokers’ needs, the health department created the comprehensive behavior modification program that incorporates the use of tailored nicotine replacement therapy (NRT) dosing and a comprehensive evaluation component.
The goal of “Put It Out Rockland” and the entire tobacco control program has been to promote quitting among youth and adults and to reduce the adult smoking rate to 12 percent by 2010. The overall objective is to provide direct cessation services and resources to people who work and live in Rockland County, with special emphasis on households of underserved populations.
The results of the first year of the “Put It Out Rockland” adult quit smoking program have been impressive. In Year I, the health department reached nearly 300 smokers, with an average end-of-treatment quit rate of 86 percent. As staff followed these smokers from the end of treatment and found a 3-month quit rate of 61 percent, a 6-month quit rate of 44 percent and 12-month quit rate of 42 percent. In Year II, the health department expanded the program to include the use of combination NRT therapy and translated the program to reach Spanish-speaking smokers. As the health department continues to modify the program and keep abreast of emerging research, staff expect to maintain and improve quit rates. To replicate this program, an organization must have access to highly trained staff, have funding for nicotine replacement therapy, and be committed to evaluation.
From the beginning of the program, RCDOH worked with an independent evaluator to design and conduct a formal evaluation, which included an annual random digit-dial community survey. The data from these surveys indicated that there was a need for a comprehensive and free adult smoking cessation program that specifically reached out to certain underserved groups in Rockland County. The Rockland County Department of Health created a comprehensive adult smoking cessation program using best practices based on behavior modification research. The program incorporated the use of nicotine replacement therapy and a comprehensive evaluation component. The staff created 10 session-specific participant workbooks, a comprehensive, a fully scripted facilitator’s manual, a set of questions and answers on issues typically raised by participants, evaluation forms, and paperwork protocol. As the health department staff were creating these materials, they continued to consult with the evaluator to create the accompanying evaluation tools and forms.
The first “Put It Out Rockland” program was piloted in the fall of 2002 with excellent results. The program incorporates an innovative spin on traditional behavior modification programs. The program structure and class meeting schedule differ from many of the programs reviewed. The program meets twice a week for the first two weeks, and once a week for the next five weeks with a maintenance session in the tenth week of the program. Also, in Year I, the program included the use of the nicotine replacement patch since the latest research showed a marked increase in quit rates with its use. As such research evolved, the health department modified the program in Year II to incorporate the use of combination NRT therapy for medically eligible participants. Although there are a limited number of studies on using combination NRT therapy, the health department determined that the available research presented a strong case for using this approach.
Agency Community RolesThe Rockland County Department of Health is the creator and administrator of this highly successful program. As the lead agency of the “Put It Out Rockland” program, the health department collaborates with more than 50 community agencies to promote the free program. The health department also relies on the expertise of agencies in underserved communities to provide suggestions for locations and promotion of targeted programs. Staff are currently working with a number of community agencies to promote the first “Put It Out Rockland” program conducted in Spanish. A member of the Lesbian, Bi-sexual, Gay and Trans-gender (LGBT) community was hired to facilitate the program and provide technical assistance on how to most effectively reach this population. A 2001 Harris Interactive Poll found that 36 percent of adults 18 and over who self-identified as LGBT, report that they smoke cigarettes, compared to 25 percent of all adults.
The organization is also a founding member of a four-county coalition that addresses local tobacco control issues and promotes smoking cessation through other avenues such as self-help, acupuncture, hypnosis, the New York State quitline, and more. The relationship with community agencies and coalitions allows the program to more effectively provide ancillary information to participants. The networking and information sharing are invaluable.
Costs and ExpendituresThe cost per participant to provide this program in Year I, regardless of quitting status, was approximately $211. This cost includes staff time ($79.68), patches for eight weeks ($120.96), materials ($3.01), and incentives ($7.75). Current research indicates that smoking cessation is one of the most cost-effective health behavior interventions, costing less than $4,400 per life saved. In comparison, cholesterol screenings cost at least $100,000 per life saved from heart disease. For both Year I and Year II, the program was funded by a share of the County’s tobacco settlement dollars.
However, the County legislature recently secured the remaining tobacco settlement payments. Fortunately, program funding will continue, thanks to the evaluation data documenting the success of the “Put It Out Rockland” program, the advocacy efforts of participants, and the support of the Commissioner of Health, the County Executive and the County Legislature. Through their accurate record keeping system, the department has a database of over 400 former program participants and another 400 smokers who are interested in attending a future program. Therefore, the health department has access to over 800 advocates who can help leverage the program’s success into support from the legislators.
One specific step taken to sustain the program is advocacy. Program participants are encouraged to contact their County legislator and or the County executive when they complete the program to advocate for continued funding. To date, this strategy has been very successful. Program participants have written letters, made calls, and been interviewed by the local newspaper to tout the successes of the program. This is a vital component for sustaining the program.