RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Harney County Tobacco Use, Perceptions, and Education: The Tar Wars Experience Project Date: 9/7/2009 Tobacco use and abuse including cigarettes, cigars, and smokeless tobacco is the number one preventable cause of death in the United States. Smoking has been linked to approximately 1 of 5 deaths annually. Each day in the United States approximately 3,600 young people between the age of 12 and 17 try tobacco for the first time. It is estimated that 1,100 of these young people will become daily users. Currently 1 in 5 Americans use tobacco on a daily basis. Oregon’s average tobacco use is similar to that of the greater United States. However regions in Oregon, like Harney County, have data illustrating much higher use in both adults and school aged children. This project was designed to investigate the perceptions and educate school-aged children in Harney County. This included epidemiological data review from Harney Behavioral Health, state data, and national data. Next, a survey investigating perceptions of 135 students, representing 80 percent 4th and 5th graders from Harney County, was created and administered. The final aspect of the project included educating 4th and 5th graders about tobacco use through the Tar Wars curriculum so young adults can make educated decisions about tobacco use. Investigating primary care provider perceptions and practices regarding smoking cessation in Florence, Oregon; and the development of a cost focused informational pamphlet Project Date: 12/29/2008 Rural areas have been shown to have higher rates of tobacco use than urban or suburban areas.(1) These higher rates have led to significant morbidity and mortality in rural populations.(3) Although state and national data has shown declining smoking rates over the past several years, these declines have not occurred as rapidly in rural areas.(2) Previous studies have found that rural smokers tend to want specific smoking cessation counseling from their doctors, including medication costs, efficacies and a specific plan.(2) This study investigated the perceptions and practice patterns of primary care physicians in Florence, in order to assess which smoking cessation tools were being used and whether Florence providers give specific weight to issues like cost and efficacy. Questionnaires were given to Family Medicine and Internal Medicine physicians concerning smoking cessation. These questionnaires showed that providers find smoking cessation to be an important goal, but that they may be underestimating the number of smokers in their practices. All of the providers mentioned patient motivation and willpower as barriers to smoking cessation, while two mentioned the cost of the therapies. Half of the providers preferred Chantix to other pharmacotherapies. With the goal of providing specific information to patients on cost and effectiveness of the different smoking cessation options, a pamphlet was developed for provider and patient use during counseling. Tobacco Cessation Group Visit Project Project Date: 10/13/2008 Tobacco abuse in the United States remains a leading cause of preventable death and disproportionately affects Medicaid recipients. At my rural site, a clinic serving exclusively Medicaid and OHP patients, an approximate 45 percent of our adult patients smoke. A significant percentage of those smokers are afflicted by smoking related illnesses such as heart disease and COPD. Having identified this at-risk population, we set forth to plan and implement a tobacco cessation group visit that is consistent with principles set forth in The Chronic Care Model and the Future of Family Medicine Project (FFMP). Adult smokers with smoking related illnesses were invited to participate based on their desire to quit. Of the 7/15 patients invited participated in the group. At the visit, our care team documented vitals and spirometry values, facilitated a group discussion about quitting, provided a brief informational presentation, and counseled patients individually regarding their plans for tobacco cessation. The visit resulted in 5/7 patients setting a quit date and creating an action plan for quitting! Several barriers to participation were identified including scheduling and transportation. A follow-up group visit is planned for January 2009, and current plans are to continue with new cohorts in the future. Elimination of tobacco use at a small community hospital as a means to better promote public health: development and implementation of a tobacco-free hospital plan Project Date: 4/30/2007 The adverse effects of smoking are well-known to health care workers and to virtually all of the general population. Yet in the face of strong data, smoking remains a prevalent activity that places a large burden on the health care system. A November 2006 report from the Public Health division of the Oregon Department of Human Services stated that “Tobacco continues to be the leading preventable cause of death and disability in Oregon.” The Tobacco Prevention and Education Program (TPEP) of Oregon has sought to better public health through a three pronged approach: 1) preventing kids from starting to use tobacco, 2) reducing exposure to secondhand smoke, and 3) helping current tobacco users to quit. As sites specifically intended for bettering and promoting health, hospitals are visible platforms for addressing public health issues. This study addressed smoking on the grounds of the Santiam Memorial Hospital and how the approach of the TPEP could be instituted to further promote a healthy community. As a plan for a tobacco-free hospital was developed, all three aspects of the three pronged approach were included. The local Tar Wars program was used a method for attempting to prevent children in the community from starting to use tobacco. Eight local 4th and 5th grade classes received anti-tobacco presentations during the month of May. A ban on tobacco use on the hospital grounds will be put into effect as a method for reducing exposure to secondhand smoke at the hospital. Thirdly, the plan for the tobacco-free hospital included several community outreach activities designed to promote tobacco cessation in the community as a whole. A brief analysis of current smoking cessation aids was also created to help hospital staff evaluate tools for helping patients, staff, and community members overcome nicotine addiction. A timeline for the tobacco-free hospital plan has been created and is currently in motion at the hospital and in the Stayton community. Patient awareness of smoke cessation resources in a Stayton family medicine clinic and Physician intervention. Project Date: 10/16/2006 Cigarette smoking has been identified as the most important source of preventable morbidity and premature mortality worldwide. Smoking is responsible for approximately one in five deaths in the United States. According to the a survey done by the Centers for Disease Control in 2002, there were 50 million smokers in he United States, of which 70% wanted to quit smoking. 41% of those smokers make at least one attempt each year, but only 7% are successful. The majority of these people (90%) attempt to quit “cold turkey.” Countless studies have shown that although this is the most common way to quit it is by far the least effective. Those who use other resources have up to a 30-45 % success rate compare with a less than 10% overall success rate for quitting cold turkey. This study was done to evaluate patients’ awareness of these resources in a Stayton family medicine clinic as well as to determine if they are being encouraged to quit by us as care givers. Through an electronic chart review it was shown that 80% of the smokers in this clinic have documentation in their chart that quitting was discussed. A survey was done and showed the following percentage of patients that knew about each of the resources available: 100% nicotine gum or nicotine patch; 57% Zyban pill; 0% SMART shot; 100% hypnosis, 71% acupuncture; 14% Chantix pill; 42% free telephone counseling. If we can better educate our patients concerning the use of quitting resources it is more likely that they will attempt to quit using them the next time. This will significantly increase the number of patients who are successful quitters and obviously markedly improve their health and the health of the community Tobacco Cessation Counseling: Are We Wasting Our Breath? Project Date: 5/1/2006 Tobacco use is a major public health concern and affects 21% of all Oregonians and 29% of residents of Douglas County, a rural area in Southwestern Oregon that includes the town of Reedsport (population 4500). It is the leading cause of premature death and disability in the state, and the medical and economic consequences of its use are well-documented and well-publicized. The purposes of this project were to research current evidence-based literature and clinical practice guidelines, and compare the current recommendations to individual practices at Dunes Family Health Care (DFHC) clinic, the major health-care provider for the town of Reedsport. This was done in order to identify areas for improvement with the intent of potentially improving patient quit rates. A questionnaire detailing their current practices regarding tobacco cessation counseling was distributed to all providers at the clinic. Results demonstrated that physicians at DFHC are consistently asking their patients about tobacco use and advising them to quit. However, similar to providers around the country, they are often not assisting patients in the quitting process by recommending over-the-counter nicotine replacement therapy, prescribing approved cessation pharmacotherapy, or referring patients to tobacco quit lines, all methods that have been shown to potentially double patient quit rates. In a presentation to providers at the clinic, each of their cited barriers to effective and comprehensive tobacco cessation counseling were addressed and strategies for improvement were given. Ideally, this project will have empowered physicians to provide their patients with the tools necessary to optimize their chances for a successful quit attempt. Substance Dependence In Josephine County Project Date: 7/4/2005 Background: The abuse of substances including tobacco, alcohol, and elicit drugs impact the wellbeing of the individual and drains the financial and social strength of the community. I-5 is a major corridor for drug traffic and smugglings. In Oregon, the nest of this problem appears to be small rural communities along this mega-highway such as those found within Josephine County, including but not restricted to Grants Pass, the site of my rural rotation. In Josephine County, 33% of adults were smokers in 2001; Alcohol was the eighth top cause of death in 2002; In 2004, the Josephine County Sheriffs office seized 25 methamphetamine labs, 7,891 marijuana plants, and 198,718 grams of drugs with a street value of $19,479,868. This study examines the availability, accessibility, and effectiveness of medical treatment and rehabilitation services for individuals with substance dependence within Josephine County. Method: Research was conducted through the internet and yellow pages, followed by questionnaires and interviews with local Josephine county healthcare providers, a hospital social worker, an addiction counselor, and representatives of local rehabilitation programs involved in the care of individuals with substance dependence disorders. Results: Findings indicate a lack of funding, dwindling services and resources, and defective communication and referral protocols are among the sources of problems with access and quality of care for substance dependent individuals. Conclusion: I propose that protocol for referral and communication between the primary care community and the mental health/substance abuse treatment community be reevaluated by a committee of representatives from all involved parties and that new protocol be established and made clear to all members of these parties for the improvement of access and quality of care to patients. Meanwhile, a chart that lists local resources and summarizes some referral protocol was developed and distributed locally to several local primary care providers. Tobacco Use Cessation in Grant County: An Evaluation of Available Resources and Development of a Patient Handout Project Date: 9/13/2004 Quitting smoking or chewing is a difficult process regardless of whether it is attempted in an urban or rural environment; however, major differences exist in community attitudes and the support resources available that impact success. This project examines how practitioners in John Day, Oregon manage patients, the resources available to offer those who are interested in quitting, and the community values that influence cessation efforts. Interviews were conducted with five family medicine health practitioners in John Day and the Alcohol and Tobacco Prevention Specialist for the Grant County Center for Human Development. In addition, a training session for managing smoking cessation in pregnant women sponsored by the Grant County Public Health Department was attended. These sessions revealed medical practitioners as the primary source for cessation information and support with no local secondary resources available for referral and a community where tobacco use, especially chew, is seen as a norm. In an effort to aid cessation counseling at both the practitioner and public health level, a handout was created to address issues faced by smokers at various stages of the quitting process. The handout can be used to supplement cessation counseling in a clinical setting where time is limited yet is also broad-based enough to help those seeking to quit outside of a practice setting. Smoking Cessation Intervention at the West Salem Clinic Project Date: 7/5/2004 According to the most recent survey done by the Centers for Disease Control, there are almost 50 million smokers in the United States, of which 70% want to quit smoking. At least one third of those who want to quit, will make at least one attempt each year, but only 7% will be successful. However, as little as three minutes of smoking cessation intervention provided by a physician, can increase the chances of quitting successfully by 50%. The U.S. Public Health Service research on smoking cessation has shown that efficacious cessation treatments for tobacco users are available and should become part of standard care giving. Furthermore, delivering treatment of tobacco users is cost-effective. Despite these national guidelines, physicians are struggling to implement smoking intervention into their daily clinical practice. Tobacco is the largest single cause of lung cancer and 82% of lung cancer deaths in Oregon can be linked directly to tobacco use. In recognition of the local tobacco problem and the national recommendations from the Department of Public Health, I have designed this research project to evaluate several aspects of smoking intervention needs, practices and procedures at the West Salem Clinic. I have additionally designed a tailored smoking assessment and intervention implementation program for the West Salem Clinic based on the results of this evaluation. Smoking Cessation in Josephine County: Identifying and Supporting People That Want to Quit. Project Date: 7/7/2003 Smoking is one of the largest public health risk factors in this country. Millions of people partake in this habit which directly contributes to heart disease, cancer and strokes, the three leading causes of death. Fortunately smoking is a modifiable behavior but unfortunately nicotine causes one of the strongest addictions known. There is great need to accurately screen for smoking status and also to effectively treat patients’ addictions. Smoking rates are particularly high in Josephine county resulting in an estimated $61 million in health care costs last year alone. The purpose of this project was two-fold. The first goal was to assess the ability of Cave Junction Family Medicine, a rural clinic, to identify and document their patients smoking status. The second objective was to create a handout aimed at educating smokers on cessation techniques and resources. Smoking rates at the clinic were determined by a reviewing all of the patient records entered into “Amazing Charts,” their electronic charting program, which was implemented approximately 6 months ago. The data showed that smoking status was not recorded in over 17% of patients, particularly adolescents, and that 54% of patients with known status have some history of smoking. Recent data states that 75% of smokers in this state want to quit and 28% would like to stop in the next 30 days. These numbers would suggest that there is a great potential use for cessation information in this community. The results of this study have stressed the need for more aggressive smoking status assessment and have shown the need for an aid to increasing cessation efforts. Understanding the patient behind the cigarette: A glimpse on smoking from the patient's point of view. Project Date: 7/1/2002 Smoking is a risk factor for the four leading causes of death in the United States, yet 24% of the adult population continues to smoke. Furthermore, studies show that only 21% of American physicians feel that they have received adequate training to help their patients stop smoking. This combination has deadly consequences. In order to assist patients in smoking cessation, a physician must possess factual knowledge, as well as an understanding of the patients being treated. Knowledge can be easily obtained from books and journal articles. Understanding a patient’s point of view, however, is only achieved by asking the patient. This study attempted to gain a greater understanding of the smoking population in the Philomath Family Clinic. The design was a tobacco survey placed at the front desk, and offered to patients as they arrived for their appointments. Completed surveys were collected for three weeks, at which point the information was analyzed. Information was also gathered from the internet regarding recommendations for physicians who treat patients who smoke. Pocket-sized cards containing these recommendations were created to be distributed to colleagues. Prevention of Smoking, Tobacco, and Illicit Drug Use by Native American School Children and Adolescents. Project Date: 7/1/2002 Smoking, alcohol, and illicit drug use cause significant health problems in society. These health problems not only affect the patient, but it affects the community as a whole. Often drugs of any kind are first tried when people are young. It has been found Native Americans on reservations have an increased rate of use of alcohol, tobacco, and illicit drugs. Additionally, many studies have found substance abuse by Native Americans whether they live on or off the reservation is increased compared to the general population. Adolescents who live on the reservation are most likely to use drugs followed by non-reservation Indian youth and finally non-Indian youth are least likely to use drugs in school. Reducing alcohol, tobacco, and illicit drug use could substantially increase the health status of Native American patients who live on or near the reservation. It has been found educating children about the effects of drugs on one's health and social relationships is an effective way to reduce substance abuse. However, it has also been noted starting the education program in high school is much too late. It is important to begin educating children while they are in elementary and middle school. This paper will outline the importance of an education program in the form of a lecture series that has medical, legal, and law enforcement contributions. A lecture was developed in conjunction with this research project to be used by my preceptor starting this fall for school aged children on the nearby Native American reservation. A basic survey was also constructed to help track the changes in substance use in the years following the initiation of this project. Smoking Cessation Efforts At West Salem Clinic. Project Date: 1/2/2002 Cigarette smoking is extremely costly to both the individual and society. It is a well established contributor to morbidity and mortality, and remains the most preventable cause of premature death in our country. Among primary care physicians, there is a high level of agreement about their responsibility to assist in tobacco cessation. Nonetheless, there are significant gaps in practice. Using a brief questionnaire, I surveyed the patients I encountered throughout my rotation to determine what percentage at West Salem Clinic are current smokers, and also whether these smokers perceived that their provider was counseling them regarding the dangers of smoking and/or advising them to quit. 41% of those questioned identified themselves as current smokers; of these, 31% felt their provider explained the health risks of smoking every visit, 62% felt it was occasionally, and 7% felt they had never received an explanation from their West Salem Clinic provider regarding the dangers of tobacco use. 54% of smokers stated their provider asked them about current smoking status and advised them to quit at every visit, 4% felt this occurred occasionally, and 42% did not recall ever being asked about their current smoking status and/or advised to quit while at West Salem Clinic. An Anti-Smoking Campaign To The Paiute Indian Youth Boxing Team. Project Date: 1/2/2002 The onset of smoking in all ethnic groups typically takes place during the teenage years, with thousands of teenagers each day becoming regular cigarette smokers. Current data shows that racial/ethnic smoking prevalence is highest among American Indian and Alaska Native teens when compared to other racial groups including Caucasians, Hispanics, Asian Americans and Pacific Islanders, and African Americans. Studies have shown that the onset of adolescent tobacco use can be curbed by education of the hazardous nature of smoking and through athletic participation. The goal of my community research project was to provide the educational aspect to a group of young men and women participating in a boxing program at the Burns Paiute Indian Reservation. Smoking Cessation Intervention in Lebanon, OR: Development of a Patient Handout for Augmentation of Clinic Intervention Project Date: 2/11/2002 Smoking continues to be a major medical issue in the United States. This study attempted to identify the effectiveness of smoking cessation intervention and community resources in a Lebanon, Oregon family practice clinic. The design was observation of family physician's interaction with patients who smoke throughout the course of a six week rotation in a higher prevalence setting. A smoking cessation class run by respiratory therapy at the community hospital is the primary source for referral if a patient is interested in quiting. This program was contacted for both interview and observational analysis. Finally, patient handout effectiveness and readiness in the clinic was observed. Whereas there seemed to be a mechanism in place to identify patients who smoke, specific intervention for smoking cessation was dependent on having symptoms or concerns directly related to side effects of smoking. Further, the only handout readily available for patients was the smoking cessation class handout. Therefore, the final product of this project was development of a patient handout for those in the pre-contemplative and contemplative stages of decision making to aid in smoking cessation counseling in a time limited clinical setting. Smoking Cessation In Grant County Project Date: 8/13/2001 Smoking continues to be one of the most significant issues in healthcare. Nicotine use and dependence has been clearly and repeatedly identified as a risk factor in a myriad of diseases and is specifically known to have an adverse affect on the morbidity and mortality associated with heart disease, hypertension, diabetes, COPD and many other ailments. However, tobacco use continues in our society even in light of its well-known risks. Certainly, smoking cessation is a key point for nearly every healthcare provider in the clinical setting. Numerous studies have described the powerful role that physicians play in smoking cessation. Many people identify their doctor's encouragement and advice as a major factor in their decision to quit and also in their ability to achieve long-term success(1). Other studies have shown the effectiveness of physician counseling combined with the physician-directed use of cessation aids, most commonly nicotine replacement (in the form of patches, gum and nasal sprays) or Zyban/bupropion (2). Even in light of this data, there are reports that physicians are still missing opportunities to counsel their patients about the risks of tobacco use and provide information about products and programs which can potentially reduce symptoms of physical and psychological withdrawal and increase a patient's chance for long-term success. For example, a recent study in the Journal of Family Practice announced that less than 50% of patients surveyed reported receiving cessation advice from their physicians (3). For my community service project, I studied smoking cessation trends in Grant County, namely: the percentage of people who identified themselves as smokers; the percentage of people who had smoked in the past and quit successfully; the number of smoking cessation attempts (successful or unsuccessful) in each group; what aids, if any, were used during these cessation attempts; if the patient had ever been advised by their physician to quit, and,; if this advice was a factor in their decision to quit. Smoking Prevention Among Elementary-Age Students In Ontario, OR. Project Date: 11/ 5/2001 In the United States, 2% of 5th graders, 28% of 9th graders, and 43% of high school seniors use tobacco. Therefore, prevention should start at a young age. Ontario, OR is a rural community, which closely follows the national trends of tobacco use. However, there is no smoking prevention program in place in Ontario. This project focused on one smoking prevention curriculum, TarWars, and how it could be useful in Ontario, OR. TarWars is a nation-wide campaign to prevent smoking among 5th graders. It has many benefits, including age-appropriate activities, community involvement, and follow-up. Successful presentations were given to 2 fifth-grade classes at May Roberts Elementary school in Ontario, OR. This school showed great interest in TarWars curriculum and plans to implement it in future school years. The Economic Burden of Cigarette Smoking at the West Salem Clinic and the Effects of Cigarette Prices on Tobacco Use. Project Date: 8/13/2001 The burden of cigarette smoking is not only manifested in disease but also in economic expense. This economic expense can be direct as in the amount spent to maintain one's smoking habit. As well the expense can be indirect as in the amount spent to ameliorate the untoward effects of the smoking habit. This study attempts to determine the economic burden of cigarette smoking in patients seen at the West Salem Clinic as well as determine the efficacy of increasing the costs of cigarettes as a means to curb smoking in this population. Not So Kool Coos Bay: Youth Tobacco Use In Rural Oregon Project Date: 7/2/2001 Despite reductions in adult tobacco use and increasing attention to smoking prevention programs, the prevalence of adolescent smoking has remained relatively stable and may even be increasing in some groups. Recent studies have found that 28% to 36% of teens are current smokers (2) Nearly 20% of Oregon's high school juniors smoke, and many of them would like to quit.(4). This project looked at teen tobacco use among adolescents in a rural pediatric practice. Patients of the Coos Bay Clinic and SWOYA aged 12-17 were asked to fill out a survey about teen tobacco use. Of the adolescents participants (n=47), a majority of those surveyed (91.5%) did not smoke or use ST. Among the tobacco users (8.5%) they selected enjoying the feeling (37.5%), Can't stop (25%), and don't know (25%) as reasons for tobacco use. These same adolescents 43.8% take cigarettes from the household, 25% have friends purchase them, and 12.5% purchase their own. Among smokers only, having friends and family members who smoke were significant predictors. Having favorable attitudes towards smoking was not a predictor. These findings show that there is an important role for rural pediatricians, in the management of teen tobacco use. Back to subject search page or search by preceptor site