A.T. Still University PA Program Stubs Out Cigarettes

A.T. Still University PA faculty Annette Bettridge, MS, PA-C, FNP, graduate Julietta Shapiro, PA-C, and nine PA students devised and piloted a PA student-led, no-cost smoking cessation program for 20 underserved male patients at the Crossroads Red Mountain Rehabilitation Facility in Mesa, Arizona.

More than six million deaths occur annually from smoking tobacco. Tobacco use has a strong correlation among those with substance abuse disorder, with an estimated 60-90% co-addicted to tobacco and another substance.

The program’s goal was to reduce the number of cigarettes participants smoked using a combination of methods to curb patient’s addiction to nicotine and ultimately improve their overall health. Prior to launching the program, PA students received training on motivational interviewing, health effects of tobacco use, and various tobacco-treatment options.

“Being able to participate in this project not only enhanced my knowledge of pharmacology and treatment plans for smoking cessation, but it gave me the opportunity to work on communication skills such as motivational interviewing,” said Destinee Bowden, a PA student involved in the project.

The program’s first step was to voluntarily enroll patients in nicotine replacement therapy (NRT). NRT uses products that contain a low amount of nicotine without the harmful toxins found in cigarettes; it reduces nicotine cravings and the undesirable symptoms that follow nicotine withdrawal.

Then, over a 14-week period, PA students engaged in one-on-one interviews with patients to explore the advantages and disadvantages of smoking, patient triggers and barriers, and short- and long-term goals. The Fagerstrom Test for Nicotine Dependence, which gauges nicotine dependence in relation to cigarette usage, was administered weekly to assess the number of cigarettes smoked, desire to use, and dependence.

Participants were also asked to keep a journal of cigarettes smoked or nicotine patches/gum used throughout the week. The written homework (journaling) proved to be a barrier for some participants and was replaced with verbal discussions documented by PA students, which encouraged participants to continue the program.

As a result of the program, three participants stopped smoking cigarettes entirely while 80% had a noticeable decrease (as measured by the Fagerstrom scale) in their average daily use of cigarettes and nicotine dependence symptoms. Four of the participants secured positions as staff members at the facility, which may suggest that smoking cessation positively influenced sustained abstinence from other substances. Additionally, 100% of responding participants expressed satisfaction with the overall experience and would recommend the program to others.

“As a prospective PA, I have a better understanding that health maintenance requires a multi-focal approach, including social and emotional supports. Just as the participants looked forward to seeing us, we as students looked forward to serving them,” shared Raven Burrell, participating PA student.

PA student Jordon Stephens added, “I left this experience inspired to carry on this [motivational] interview style with me into my second year of PA school.”

Plans to sustain this project through continued collaboration among A.T. Still University, Crossroads, and their partners are already underway.

Crossroads Inc., is the only provider of substance abuse treatment that offers no-cost scholarship services to individuals who otherwise can’t afford treatment. Crossroads runs seven facilities, including Red Mountain Rehab where this project took place. The patients at the Crossroads Rehab facility struggle with substance abuse, mental illness, limited access to care, and poverty.

This program was funded by the nccPA Health Foundation’s Be the CHANGE grant with additional support from Crossroads staff and private donors.

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