Evaluating the Implementation of a Comprehensive Tobacco Cessation Program

Introduction: Tobacco use remains the leading cause of death in the United States. Smoking cessation at any age provides numerous health benefits and added years of life. The Stanford Tobacco Cessation Program (STCP), started in December 2014, is a comprehensive cessation program that includes group sessions, mindfulness training, NRT and medication management.
Aims: This evaluation examined tobacco cessation outcomes among patients referred to the STCP. Specifically, we examined 1) baseline patient variables predictive of initiating and engaging in tobacco cessation treatment with the program; 2) quit rates at 3- and 9- months for patients who did and did not engage in tobacco cessation treatment with the program; and 3) among those who initiated in tobacco treatment, patient characteristics predictive of being tobacco-free at the 3-month or 9-month follow-up periods. We also summarized reasons for patient non-participation and patient feedback concerning program effectiveness.
Methods: A total of 227 patients have been referred to STCP to date (May 10, 2018); 102 (45%) have completed an intake; and 76 patients (33%) have attended at least one group session. Self-reported 7-day prevalence abstinence from all forms of tobacco at 3-month and 9-month follow-up periods were examined by demographic and baseline characteristics.
Results/Findings: Patients who engaged in treatment with the STCP had significantly higher quit rates than those who were referred and did not proceed in the program (41% vs 11% at 3-months and 54% vs. 31% at 9-months, respectively). Cancer diagnosis and NRT use were predictive of not initiating in the program. Substance use and current NRT use were significant predictors of not engaging in the program. Patients with mental illness were just as likely to engage in treatment and quit smoking as patients without mental illness. A majority (57%) of patients who were referred but did not join the program cited insurance as a barrier.
Conclusions: The STCP is supporting patients with quitting smoking, though remains underutilized. There is opportunity for program growth with a need to address significant barriers to patient participation in the program.