1. “Smoking Cessation among High-Risk Patients”
Dr. Arpitkumar A. Patel, BDS , MPH Candidate, West Chester University
Dr. Debra Bill, MPH, PhD, MCHES, Advisor, College of Health Sciences, West Chester University
Dr. Kari R. Hexem, DMD, MPH , Site Supervisor, Dental Director ,Philadelphia FIGHT Dental Services
Discussion
For questions or comments :
Philadelphia FIGHT Dental Services
(215) 525- 3046 E-mail: dental@fight.org
Introduction to the Problem
• Philadelphia FIGHT was originally founded as one of the
national clinical trial sites for American Foundation of AIDS
Research in 1990. FIGHT stands for Field Initiating Group for
HIV Trials (FIGHT). Philadelphia FIGHT in coalition with
University of Pennsylvania School of Dental Medicine began
providing dental services in 2013.
• Mission: “Philadelphia FIGHT is a comprehensive AIDS
service organization with a mission to provide state-of-the art,
culturally competent primary care to low income members of
the community, HIV specialty care, consumer education,
advocacy, social services, and outreach to people living with
HIV and those who are at high risk, including family members,
communities with high rates of HIV, formerly incarcerated
persons, and young people at risk, along with access to the
most advanced clinical research in HIV treatment and
prevention.”
• Vision: FIGHT Vision is to end the AIDS epidemic within the
lifetime of people living with HIV/AIDS now.
• The Philadelphia FIGHT started as one of the site for the
clinical trial and it has grown into a independent health care
organization dealing not only with HIV/AIDS but also helps
people recover from substance abuse, mental health problems,
dental problems and over all health problems.
• Cigarette smoking is the leading cause of preventable disease
and death accounting for more than 480,000 deaths every
year in United States.
• The cigarette-smoking rate in the state of Pennsylvania is
22.4% as of 2011 which is higher than the national median
rate, which is 21.2%.
• According to the Centers for Disease Control and Prevention
approximately 19% of adults in the United States are smokers.
•
• The smoking rate is two to three times higher among adults
who are HIV-positive.
• People with HIV who smoke are more likely to suffer
complications from HIV medication than those who do not
smoke.
• Philadelphia has the highest rate of adult smoking among the
10 largest U.S. cities, at 25.2%. Additionally, 7.3% of
Philadelphia high school students are regular smokers
because of highest number of retailers and lower price of
cigarettes per pack as compared to other large cities across
the United States.
Literature Review
• In literature there is a strong evidence of narrative
communication or storytelling as an effective means to promote
behavior change in many communities especially African-
American Communities and sharing peer experiences for
smoking cessation.
• In a study conducted in New Zealand, an SMS based study
called “Do you smoke after Text” study showed an increased-
quit rate of 28 % as compared to control group, which was only
13%. In one more pilot study conducted in UK, which was the
modified version of New Zealand Study known as “Txt2Stop”
the study reported quitting rate of 26% in the intervention
group, compared to 12 % in the control group. In the main
study the intervention group has quitting rate of 19.8% in
comparison with 12% in the control group. The components of
interventions were based on the various behavior change
social theories or evidence based guidelines for smoking
cessation for the period of 6- 12 weeks.
• In today’s world Nicotine Replacement Therapy (NRT) is the
common smoking intervention tool kit available to the smokers
who are ready to quit. In the meta-analysis study conducted
before at 132 NRT trials site, the study showed significant
results for increase rate of smoking cessation by 50% to 70%.
In spite, of increased availability of over the counter NRT
medications and nicotine patches only three studies have been
conducted involving NRT and HIV patients.
Program Goals and Objectives
 Project Goals
 To increase awareness about the harmful effects of smoking
among HIV positive individuals and those at risk for HIV in
greater Philadelphia region and secure funding for the project
 Process Objectives
 To conduct smoking cessation sessions and help participants
quit this habit by using different strategies based on their
needs.
 To create educational materials, that includes all the information
presented in the program and for future facilitation of the
program.
 To act as a resource person and health educator.
 To recruit a minimum of 85-100 participants for the educational
session.
 To convince 60% of the adults participating in smoking
cessation to sign up for evidence based text message service.
Program Goals and Objectives
 Learning Objective
 To gain an understanding of how non-profit organization
functions, while attending departmental meetings.
 To identify the potential barriers in delivering health care as a
public health professional.
 To effectively plan and implement a community health
education program.
 To increase participants knowledge about coping strategies
with cigarette cravings and stress.
 Outcome Objectives
 To reduce the prevalence rate of smoking among high-risk
patients.
 To evaluate the efficiency of educational sessions and evidence
based text messages on the rate of smoking cessation.
 To increase the participants knowledge of health effects of
smoking and interaction with HIV medications by at least 40%
from pre-test assessment to post-assessment.
Background
Activities
 Grant Writing
 In the implementation phase, the grant was submitted to
American Dental Association for funding the project
 Participants
 Individuals who are current or former smoker regardless of
age, gender and race can sign up for the program.
 Educational materials
 Smoking Cessation guide was given to the participants who
attended the educational session. The smoking cessation
guide was a modification of American Lung Association Guide.
 Questionnaire
 The Pre-test questionnaire consisted of seven close-ended
questions and the post-test questionnaire consisted of one
open-ended & six close ended questions. The questionnaire
was a modification from Center for Program Evaluation and
Research.
 Sign Up for Text Message
 During Education Sessions each participant was informed
about an option to sign up for text message service via
www.smokefree.gov. The information needed to sign up for
SmokefreeTXT was collected with the Pre-Test questionnaire.
All the participants were assisted in signing up for the text
message service. They also had an option also sign up for
themselves.
In Philadelphia region, almost 30,000 people are living with
HIV and 42% of the them are smokers. Smoking accelerates
the progression of HIV towards AIDS. CDC recommends after
the individual receives medication for HIV, Smoking Cessation
should be prioritized because people with HIV who are current
smoker are less likely to adhere to the HIV treatment plan.
The prevalence rate of cigarette smoking among homeless
people is approximately 70%, which is three times higher than
the national average. Tobacco-related illnesses such as heart
diseases and cancer are two of the three leading causes of
death among homeless persons because of the fact that
smoking cessation research most of the times has excluded
persons who does not have the place of residence.
Due to the time constraint, the implementation of the
program was conducted on a very small scale. It was
challenging task to convince the participant for follow-up.
More Information
Recommendation
Future Research: Identify difference in the results between
educational session with text message service versus
educational session without text message service
Give out incentives to all the participants to encourage them
to participate at the end of the program.
Recruitment of the participants was a challenging task, more
program promotion is needed.
Strengthen relationships with other health care providers to
increase the number of participants in the study.