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Tobacco Cessation: Communities Putting Prevention to Work
In 2010 the Massachusetts League of Community Health Centers (the League) partnered with the Boston Public Health Commission to participate in "Communities Putting Prevention to Work" (CPPW), a two year national American Recovery and Reinvestment Act (ARRA) initiative funded by the Center for Disease Control and Prevention (CDC). The League was asked to improve the tobacco cessation infrastructure at nine Boston-based health centers by training oral health staff to screen, provide a brief intervention, and refer adult patients who use tobacco to additional cessation services. Three training sessions conducted by UMass Medical School were attended by a total of 52 oral health staff. The League also integrated QuitWorks into health centers' oral health departments, a first of its kind free tobacco cessation service developed by the Massachusetts Department of Public Health.
Tobacco screenings began in late winter of 2011 with centers implementing on a rolling basis. Oral health staff began asking patients if they used tobacco at routine dental visits. If the patient responded that they did use tobacco products, they received a brief counseling intervention and were asked if they would like a referral for treatment services. If the patient agreed, the staff member would fax the information to QuitWorks or document that a referral had been made to in-house or community-based services.
Prior to this project, there was limited documentation of tobacco screenings and no standardized protocols for tracking screening and counseling by oral health providers. For the period March 2011 to February 2012, a total of 17,893 screenings occurred at the nine community health centers, a significant increase in the number of health center patients who were screened and counseled about tobacco use. Further analysis of the data collected for this initiative showed that 15.7% of the patients screened reported using tobacco products. This is very close to the city of Boston rate of tobacco use (16%). A total of 1,013 of these identified tobacco users were referred for additional treatment, including referrals to QuitWorks, primary care and in-house tobacco cessation services. In addition, participants received educational materials about the health implications of tobacco use.
As the grant period approached its end, each of the nine health centers sent a champion staff member to attend a "Train the Trainer" Tobacco Program in order to sustain the program infrastructure after the grant period. Given the success of this initiative, participating health centers plan to continue to implement the tobacco protocols they developed.
Participating Health Centers:
Boston Health Care for the Homeless Program
Codman Square Health Center
The Dimock Center
Fenway Health Center
Geiger Gibson Community Health Center
North End / Waterfront Health
South Cove Community Health Center
South End Community Health Center
Whittier Street Health Center |
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Who's Who: Colleen Anderson, Dentist at
Boston Health Care for the Homeless Program
Originally from Detroit, Colleen always knew she wanted to be involved in public health. Cemented through her initial commitment to the National Health Service Corps, Colleen's passion for public health has continued to grow over the course of her dental career. Driven to "provide quality care for people who really need it and have a hard time getting access to it," Colleen went to work for the Boston Health Care For the Homeless Program (BHCHP) after her general practice residency at Brigham & Women's Hospital ended in 2009.
In addition to providing primary health care services that include behavioral health and dental services, BHCHP also offers respite care for homeless individuals suffering from serious illnesses, such as cancer. What many do not realize is that the health center coordinates with seventy to eighty different homeless organizations (including shelters, respite, and transitional programs) to help their patients cope with often highly complex medical conditions.
Through BHCHP, Colleen had an opportunity to join the Tobacco Cessation Initiative which aims to facilitate the increase in tobacco screenings by oral health providers. The Initiative provides health centers with supplementary resources, trainings, and one-on-one meetings with League dental program staff members Shannon Quirk and Victoria Walsh.
For health center staff, the Initiative has formalized the tobacco screening process and provided a more consistent method of documentation. "The program has increased our effectiveness in approaching dental patients about their tobacco use," says Colleen. "Most important, we are better able to connect them to services if they are ready to quit." Serving as the point person at her health center for the Initiative, Colleen helps to set goals and measures, collect data, and make sure the staff stays energized and on track.
BHCHP is in a unique position to benefit from the Initiative. According to Colleen, BHCHP's patient population is at a disproportionately higher risk for smoking. Colleen explains that at any other health center the smoking rate averages about 13% of the population, but for the homeless population the rate skyrockets to between 70% and 80%. With expanded resources and support, the health center has been able to increase the number of patients they refer to the QuitWorks program and to set up consistent screening and tracking processes which improve their ability to follow up with patients. "It's a solid start to alleviating a significant public health issue among our patients," says Colleen.
Colleen also points out that the program's long-term view and ability to dovetail with other anti-tobacco initiatives provide considerable value to BHCHP and other health centers. Says Colleen: "A nice part of the program is that these changes are not meant to last for a year, but rather are focused on long-term changes and what works for each individual health center. The program has also coincided with BHCHPH's other efforts to address smoking across our patient population. Together, these systemic changes are contributing to an easier quit environment within the health center."
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