Case studies on how college student health services infuse 5 A's into their protocol – 4/16/09

Q: Do any states have any case studies describing how college campuses have infused the 5 A's into their Student Health Services protocols? South Dakota is currently partnering with the Minnesota Institute of Public Health to develop a Post Secondary Tobacco Prevention Toolkit to provide to our SD colleges & universities.  This toolkit will serve as a manual that will assist with the planning and implementation of tobacco prevention/cessation efforts.  Our hope is to include a model or a case study of a college/university that has implemented the "Treating Tobacco Use and Dependence" Clinical Practice Guidelines into their Student Health Services on campus.  Please provide copies of any case studies or recommendations for where we may be able to obtain a case study example.

A:

1. Alabama: The Alabama Department of Public Health provides Ask, Advise, Refer, Prescribe (AARP) training to healthcare and social services providers.  The trainings are conducted by the 11 Area Tobacco Prevention and Control Coordinators.  The AARP protocol is a shortened version of the 5 "A"s.  The providers are trained to ask every patient about their tobacco use status at every visit, advise those who use tobacco to quit, refer tobacco users to the Alabama Tobacco Quitline for free cessation assistance, and if the provider feels that it is appropriate, prescribe meds. The Alabama Tobacco Quitline provides medically eligible callers who participate in counseling with 4 weeks of free nicotine patches.  Patients with potential medical contraindications for nicotine replacement therapy must obtain a written prescription and have the medical clearance form filled out by a licensed medical doctor in order to receive the nicotine patches.
    
   The coordinators visit every college/university health center in their target cities at least once a year to offer/provide the AARP training and Quitline materials.  We have found the colleges to be very receptive to the training and the coordinators have also provided the AARP training to nursing and other allied health program students, as well as students in counseling/clinical psychology programs on campus.  The AARP training and materials are also offered in the student counseling centers. See a copy of the AARP PowerPoint.
    
2. California (1): Most campuses don’t necessarily “infuse the 5 A’s” into their programs, but they do some of the A’s (e.g., ask people if they use tobacco, advice them to quick, etc.).  The best thing the person from South Dakota can do is review the research on college smoking cessation, determine what her/his campuses are able to do (based on funding, staff, time, etc.), and then support their programs.  It is hard to tell any group of campuses what one cessation protocol to use since every campus is different, has a different study body, and has different levels of funding/staff to support cessation services.  Overall, though, I can tell you that most campuses have struggled with group counseling session and the 7 to 8-week counseling group sessions (to long for most college student to stick with).  Successful programs include offering free NRTs to students; offering free quit kits; offer one-on-one counseling sessions, internet cessation classes, helpline services; and, offering course credit for taking a cessation class.  Of all the campuses I work with, the colleges with the highest rate of quitters (and people seeking cessation support) always offer free NRT product.
    
   Here are some resources that might be useful. See our Cessation Toolkit. Also, we did a survey of cessation services available at California colleges back in 2005.  It was an informal survey but we did get some good raw data that we can share.
    
   Resources:
   • Presentation on Young Adult Tobacco Use and Cessation
   • TTAC Literature Review
   • Bacchus Cessation site

   Good Contacts:

   • Linda Hancock, Virginia Commonwealth University (Practitioner, Researcher)
   • Abigail Halperin, University of Washington (Researcher)
      
3. California (2): California does not have any case studies specific to our program on this topic, but here are a few citations from Medline:
    
   • A case-based clinician training program for treating tobacco use in college students. Halperin AC, Thompson LA, Hymer JC, Peterson AK, Thompson B.
     Public Health Rep. 2006 Sep-Oct;121(5):557-62.
   • A review of interventions to reduce tobacco use in colleges and universities.
     Murphy-Hoefer R, Griffith R, Pederson LL, Crossett L, Iyer SR, Hiller MD.
     Am J Prev Med. 2005 Feb;28(2):188-200. Review.
   • Healthcare providers' treatment of college smokers.
     Koontz JS, Harris KJ, Okuyemi KS, Mosier MC, Grobe J, Nazir N, Ahluwalia JS.
     J Am Coll Health. 2004 Nov-Dec;53(3):117-25.
   • College smoking policies and smoking cessation programs: results of a survey of college health center directors. Wechsler H, Kelley K, Seibring M, Kuo M, Rigotti NA.
     J Am Coll Health. 2001 Mar;49(5):205-12.
      
4. Oklahoma: The Oklahoma State University Tobacco Use Prevention Program in coordination with its medical staff, implemented a system to screen every student tobacco user that comes to the Student Health Services, see the Patient Tobacco Use Assessment and Follow-up forms. The medical staff integrated the 5 As as a routine for each tobacco user. Our program provides free cessation medication to uninsured students. Response from student tobacco users has been satisfactory, with higher demand in September, and February; the final exam months April and December show decrease of service utilization.
    
5. West Virginia - No “case studies” on this topic from WV.

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