This document describes the Helpers Program, a social and community network approach to tobacco cessation. The Helpers Program trains community members to have "helping conversations" that encourage and support tobacco users who want to quit. It is based on research showing the influence of social networks on health behaviors and that quit attempts are often unplanned. The Helpers model provides web-based or in-person training to help community members feel confident having supportive conversations about quitting resources. Several research projects have tested the Helpers approach in various communities and found it increased knowledge and helping behaviors. The goal is to engage social networks and foster communities that support tobacco cessation.
2. Communities as Change Agents
Helpers Program: A Social & Community
Network Approach to Tobacco Cessation
Myra Muramoto, MD, MPH
The University of Arizona College of Medicine,
Department of Family & Community Medicine
4. Acknowledgements
Partners
Pima Community College Partnership for Tobacco-Free
Maine
Maricopa Community College
Mississippi State University
Mesa Community College
Northern Arizona University
Free & Clear (now Alere)
University of Alabama
ICA Mississippi Head Start
University of Minnesota
Arizona WIC Clinics
Mohave County health Dept
Outer Limits
Tanner Corporation
Child Time
Cortiva institute
Arizona Smoker’s Helpline
New Jersey Tobacco Control
American Specialty Health
Program
Maricopa county Health Dept.
Coconino County Health Dept.
The University of Arizona Health
Network
5. Why?
How do we reach people….
… beyond the healthcare system?
… beyond the worksite?
… across barriers to access?
Reach people where they are.
6. Social networks & smoking cessation
Chance of smoking
decreased:
67% if their spouse quit
25% if adult sibling quit
36% if their friend quit
34% if coworker quit
“cascades of quitting”
3 degrees of separation
(Christakis, 2007)
9. Quitting is not always planned
Patients’ report of quit attempts (Larabie, 2005)
51.6% unplanned, 64% unaided
Many reasons for unplanned successful quits
National household survey (West, et al., 2006)
48.6% of most recent quit attempts were unplanned and
acted on immediately
Unplanned attempts more likely to be successful
Decisions to change often impulsive (West, 2006)
Accumulation of nudges
3 T’s
10. Brief Tobacco Interventions
Continuum of cessation services
Interventions by multiple health professionals increase
quit attempts and quits (An, et al., 2008)
Population effect – “increase in quit attempts matters
more than the same level of increase in the use of help.”
(Zhu, 2007)
Any attempt is better than no attempt
11. To Increase Quit Attempts
Change social norms…
Quitting is normal
Repeated attempts are normal, so keep trying
Help tobacco users feel more hopeful
Reduce perceived barriers to cessation aids
13. “Health Influencers”
Family & friends
Co-workers
Educators
Service providers
Strangers
Have motive…
Have opportunity…
Are engaged
Campbell, et al., 2007
15. “Trusted members of the
community…”
....trusted by
relatives, friends, and
co-workers, the very
people for whom the
interventions were
designed.”
(Thomas, 2001)
16. Seeking help on behalf of others….
….7% of all callers to
California quit line, more
on non-English lines
(Zhu, 2006)
17. Quitting tobacco is a process…
“A journey of a thousand
miles begins with a single
step.”
Lao Tzu
18. … a journey…
Helpers encourage…
… The first step
… The last step
… A step along the way
… Not giving up on the
journey.
19. What is the Helpers Program?
What is underlying research?
20. The Helpers Program…
Training, support,
resources for
“helping
conversations”
Foster communities
of practice
5 main
components
25. What did we learn?
Who came forward
Increased
knowledge, confidence, an
d helping behavior
Minimal intervention
increased helping behavior
Referred to
services, discussed
medications
Contextual influences on
helping
Muramoto, et al, 2007; Castaneda, et al, 2008, Yuan, et al, 2010
26. Helpers Free & Clear study
Worksite
dissemination pilot
Helpers Web
components only
Feasibility
Utilization
Muramoto, et al, 2010
27. Helpers New Jersey
In-person & web training
Community Resource
Center
Helpers Quit Kits
Community creativity &
experimentation
30. Communities as change agents…
Need community-based approaches
Engage, activate social networks
Foster communities of practice
Helpers arose out of a decade of community-
based research
Still evolving based on community needs
The 3 T’sCreate “motivational tension” in smoker’s environment.Trigger action in those who are contemplating quitting.Ensure that treatment, including brief counseling, is immediately available.
Key compo
Have the opportunity to help promote healthy behaviorsHave access to high-risk and hard to reach populationsMotivated, engaged
“Proxies” - non-smokers calling on a smokers behalf (Zhu, 2006)7% of all callers to California quitline (~22,000 in 7 years)Non-English lines had a more proxy callers
Randomized trial of brief intervention training for health influencersIn-person classroom trainingWeb-based trainingMailed materials with brief motivational sessionQuantitative OutcomesProportion of participants reporting providing BIsCompletion of “5 A’s”Qualitative study of health influencers experience with providing BIs
Worksite dissemination with Free & ClearUsed only Helpers Web componentsThree large national corporations3 month pilot, target audience of n=102,100Site utilizationCreated user account on site– 4727Registered for training – 1427Completed training – 766Clicks on referral links – 201Deployed nationwide across multiple corporation and ISP infrastructures with very few problems
Feasibility study of multiple Helpers components – still ongoingIn-person training (training of trainers)Helpers Community Resource Center web-site Quit KitsHelpers is a good fit with state tobacco program’s community-based approach to cessation Both in-person and web-being training in useTrainers starting to get creative about using Helpers training for outreach and engagement of community partners
RWJF Consumer Demand Roundtable project – to explore innovative ways of tobacco users to seek evidence-based treatmentDeveloped with IDEO – world-renowned design firmConsider: How are print and other distributed materials used to promote cessation?How could they be used more effectively?Possibilities:Outreach Kits to promoting organizations’ cessation activities/services to partnersGive-away’s at community eventsResources to mail or give to community members asking how to help someone quit