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© 2008 American Public Health Association
DOI: 10.2105/AJPH.2007.128355
LETTER |
Haijun Xiao and Guillermo Brito are part of the Research and Evaluation team at the American Legacy Foundation, Washington, DC. Christopher D. Hoffman, Cindy L. Laton, and Sallie Beth Johnson are with FirstHealth of the Carolinas, Inc, Pinehurst, NC.
Correspondence: Requests for reprints should be sent to Haijun Xiao, MS, American Legacy Foundation, 1724 Massachusetts Avenue, NW, Washington, DC 20036 (e-mail: jxiao{at}americanlegacy.org).
A recent article by Lee and Kahende1 identified predictors of successful smoking cessation to assist practitioners in tailoring programs for clients at high risk of relapse. These researchers found that cessation was significantly associated with the following factors: having rules against smoking in the home and a tobacco-free workplace; being at least 35 years of age, married or living with a partner, and of non-Hispanic White race or ethnicity; and having only 1 lifetime quit attempt and not having switched to low-tar or low-nicotine products. Research conducted by FirstHealth of the Carolinas, a not-for-profit health care system based in Pinehurst, NC,2–5 both supports these findings and identifies other factors to consider toward preventing smoking relapse.
FirstQuit is our comprehensive, evidence-based cessation program that provides individual and group counseling to clients who smoke and are referred for treatment from provider offices in our rural, tobacco-growing service region. Program data corroborate the role of stress and addiction in hindering the cessation efforts of clients (Table 1).
Stress played a large role in smoking relapse over time, as close to 50% of smokers identified stress as the reason for relapse up to 1 year after cessation (Table 1). This suggests the utility of incorporating on-going stress management components into tobacco cessation programs. Addiction, as indicated by physical urges or withdrawals, influenced relapse most particularly during the first 3 months after the initial quit date (Table 1). As expected, there was a decrease in reported symptoms of withdrawal over time.
On the basis of these findings, FirstQuit has tailored its program to address stress and addiction by adding a component to educate clients about the symptoms of nicotine withdrawal, the reasons for their occurrence, and specific coping strategies. Clients are reminded that withdrawal symptoms are temporary and a sign that the body is healing itself. Ensuring access to nicotine replacement therapies and cessation medications to overcome physical addiction is now focused on the time period closest to the quit date and continued according to each client’s needs.
In addition, stress is addressed continually throughout follow-up. Clients receive a stress management guide and relaxation CD, are invited to attend ongoing weekly support groups, obtain a trial membership to a fitness center, and are connected to additional local resources for mental health assistance (if necessary). Enhancing cessation interventions with timely, tailored resources that address stress and addiction may enhance efforts to prevent relapse in the Carolinas and elsewhere.
Acknowledgments
This study was supported by the American Legacy Foundation/Community Voices initiative and First-Health of the Carolinas, Inc (grant #4125).
We thank Donna Vallone, Jennifer Duke, and Mary Northridge for their guidance and insightful comments on previous drafts.
Accepted for publication October 15, 2007.
References
1. Lee C-w, Kahende J. Factors associated with successful smoking cessation in the United States, 2000. Am J Public Health. 2007;97:1503–1509.
2. Hartsock LG, Hall MB, Connor AM. Informing the policy agenda: the Community Voices experience on dental health for children in North Carolina’s rural communities. J Health Care Poor Underserved. 2006; 17(suppl 1):111–123.[Medline]
3. Leopper R. Integrating health care into the one-stop system for workforce development as a safety net for ex-offenders. Am J Public Health. 2006;96:1147.
4. Formicola AJ, Ro M, Marshall S, et al. Strengthening the oral health safety net: delivery models that improve access to oral health care for uninsured and underserved populations. Am J Public Health. 2004;94:702–704.
5. FirstHealth Community Voices. Health care for the underserved. Available at: http://www.communityvoices.org/Community.aspx?ID=12. Accessed September 26, 2007.
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