Tobacco cessation hits close to home

December 22, 2011

In the wake of new Dallas-area, nicotine-free hiring policies, find out how TAMHSC-BCD’s tobacco treatment clinic takes on new importance and how it has changed the lives of 3 former nicotine users.

Tobacco cessation programs like the one at Texas A&M Health Science Center Baylor College of Dentistry may just take on new relevance, considering recent announcements from neighboring Baylor University Medical Center at Dallas.

Starting Jan. 1, all new medical center hires must be nicotine free and will be subject to initial nicotine screenings. Current employees will have access to tobacco cessation services free of charge, but employees and their spouses who continue to use nicotine will be responsible for a $25 surcharge each pay period if they’re under the health care system’s medical coverage.

While this nicotine-free hiring policy — the first of its kind for a major Dallas employer — doesn’t directly impact the dental school, as more employers adopt such practices, individuals may increasingly rely on cessation programs like the one at TAMHSC-BCD.

Combining education with patient needs

Since Baylor Tobacco Treatment Services the only dental tobacco cessation clinic in Texas, to date — opened in 2004, dental hygienist and clinic counselor Elain Benton estimates she’s seen approximately 700 patients, who receive telephone follow-up on a regular basis unless they decline. Benton is Baylor Tobacco Treatment Services’ third counselor; two other certified tobacco treatment counselors who developed the clinic with Dr. K. Vendrell Rankin, professor and associate chair of public health sciences, and director of the clinic, also have worked in the same capacity.

The clinic initially was supported through funds allocated to each of the state’s health science centers from an independent Texas lawsuit because it was not part of the Tobacco Master Settlement agreement. TAMHSC’s grant to Baylor was $50,000, and the public health sciences department elected to use the funds to start the tobacco cessation clinic.

It has evolved through direct salary support and grants obtained by the public health sciences department. Its services — which were originally geared to help patients of record, faculty, staff and students quit tobacco use at no cost — has grown to include patient referrals from clinicians outside the dental school.

Having the tobacco cessation center conveniently located on the college’s seventh floor offers dual benefits. Patients can receive counseling from Benton a certified Mayo Clinic tobacco treatment specialist and students can learn how to approach chairside counseling.

“It’s about meshing education for the students and the needs of the patients,” says Rankin. Rankin gives three formal D2 lectures as part of the curriculum, and Benton gives two dental hygiene student lectures. Rankin’s other two formal lectures are geared toward helping D3s learn motivational interviewing skills. Benton reinforces this technique with students through one-hour role playing sessions.

Addressing physical cravings and emotional needs

Services at the cessation clinic are free, but Benton does not distribute medication. Rankin consults with Benton to make recommendations and write prescriptions when indicated, so that the program stays in line with national clinical practice guidelines for treating tobacco use.

Perhaps Benton’s most crucial role is addressing patients’ emotional needs as they start on their quitting journey.

“Patients like the one-on-one contact. A lot of them ask me, ‘Can I come back next week?’ They recognize that they need follow up and support,” says Benton, sitting in the clinic, which exudes a cozy office feel with its circular table and bookshelves filled with brochures and pamphlets.

“I’m very respectful of where they are in their quit attempt,” says Benton. “A lot of people make judgments and try to force them to make decisions when they might not be ready. Our clinic doesn’t work that way.”

Rankin, also a certified Mayo tobacco treatment specialist, offers her perspective, gleaned from 15 years of experience in tobacco cessation.

“It’s about helping them to develop their choices,” says Rankin, “and about helping them weigh the pros and cons in order to make the decision for themselves.”

Breathing easier: in their words

Read more about three patients who made the life-changing decision to quit using tobacco and how Baylor Tobacco Treatment Services helped them through the process.

David’s story: Hasn’t used tobacco since: October 2009

David walked by the same co-worker very day, and eventually her comments wore him down. Coincidentally, these exchanges occurred during his long-awaited cigarette breaks.

All she would say is, ‘You know you need to stop that,’” David says. “Every time she saw me she would say this.

“About a month before I came to see Elain, I thought, ‘She’s right; I do need to stop. I can do this.’”

After all, it was something David had done before. After 17 years of smoking, David hadn’t smoked for seven years. About three years after starting up again, he sought Benton’s help.

His co-worker’s urgings, coupled with advice from TAMHSC-BCD’s dental students during his appointments, prompted David to try the TAMHSC-BCD cessation clinic. After using a combination of the NicoDerm CQ patch and Nicorette Gum, David was able to quit. That was just over two years ago.

He says that since then his teeth are in better shape, his car smells better and he no longer has any need for those routine smoke breaks.

Even so, he still battles with sensitivity to cigarette smoke.

“I can smell smoke a mile away,” says David.  “I have to get away from it ASAP, because the cravings really eat at me when I can smell it.”

David may very well be one of Baylor Tobacco Treatment Services’ greatest champions.

“I wish more people knew about it,” David says of the clinic. “I keep Elain’s card in my desk and my wallet just in case. I know that if I ever call her, just hearing her voice settles me down. Nothing has been as personable as the clinic at Baylor.”

Janis’ story:  Hasn’t used tobacco since: March 2011

By the time Janis decided to enlist the support of the college’s tobacco cessation program, smoking had become ingrained in her everyday routine. First thing in the morning, it was coffee and cigarettes; then there were car rides.

“Whenever I would get in a car I would light up a cigarette,” Janis says.

Janis decided to try Chantix, which eased her withdrawal symptoms and cravings. Even so, she still had a desire to smoke.

“It was really hard for me to learn how to sit still and not do anything,” Janis says. “It was a slow process. I had to learn a whole new way of living.

“I tried little things. I tried little hand games; I tried crochet. It was a mindset I had to change.”

And change she did. Janis, who in 30 years had worked up to a pack of cigarettes a day and had never attempted to quit, made the decision to stop smoking in March 2011. While at the college for dental services, her student dentist mentioned the college’s clinic to her. She then contacted Benton and started the program.

“If I just had any questions or any issues, or if I was feeling a little weak, I’d call Elain and talk to her. She was always very helpful, very supportive,” Janis says.

She also drew from her own resolve.

“It was a decision I knew I had to make,” Janis says matter-of-factly.

Ruby’s story: Hasn’t used tobacco since: March 2010

When Ruby felt stressed out by her grandkids, she’d reach for her cigarettes and make a beeline for the front porch of her Mesquite, Texas, home. It was there she’d go for a moment of relaxation, a moment to breathe. These moments — and others throughout her day — added up. It was so subtle, in fact, that over the course of 30 years Ruby had worked her way up to a pack a day.

Throughout those three decades, Ruby had tried to quit smoking but to no avail.

“I would lie in bed so I could handle the withdrawals,” Ruby says. “If I got up, the withdrawals would overtake me. That’s what you run from, and that’s what you run to — the withdrawals.”

That changed when Ruby sought help from Baylor Tobacco Treatment Services, Texas A&M Health Science Center Baylor College of Dentistry’s tobacco cessation clinic.

Elain Benton, dental hygienist, public health sciences instructor and the clinic’s certified tobacco treatment counselor, recommended that Ruby try Chantix, a prescription medication designed to help adults quit smoking by reducing cravings.

“I believe when I started taking the pills it helped me to get control,” Ruby says. “The pills would take the hurt, the craving, of that withdrawal.”

After Benton and Ruby’s initial meeting, Benton was available for follow-up appointments and phone calls when needed. Like the hundreds of other patients seen at TAMHSC-BCD’s tobacco cessation clinic, the combination of counseling and prescription recommendations gave Ruby the push she needed to quit.

Nowadays, things for Ruby couldn’t be better.

It’s a July afternoon during this particular phone conversation when Ruby reveals she hasn’t touched a cigarette for more than a year and doesn’t plan on it. Her grandkids notice, too.

“My grandbabies are happier,” Ruby says. “It’s awesome, and I love the praise they give me.”

Before hanging up, Ruby offers some simple words of encouragement to smokers looking for ways to quit.

“Don’t give up,” Ruby says. “If you never give up, you’ll see. You’ll succeed.”


— LaDawn Brock