—by Matthew K. Weiland and Paul M. Kubek
Portsmouth, OH—The Shawnee Mental Health Center not only serves three of the poorest, most rural regions in Ohio—Lawrence, Scioto, and Adams counties—with mental health and tobacco recovery services, but it also lies in the heart of tobacco country, making the notion of kicking the habit seem less doable than flicking a cigarette butt across the Ohio River.
From political influence to business interests, tobacco has been a livelihood and a way of life for families and communities for generations. "When you're trying to promote an idea like tobacco cessation, it makes it very hard when you have all these major obstacles. It really creates a serious challenge," says Flash Phipps, Ph.D., PCC-S, adult program supervisor for Lawrence County at the Shawnee Mental Health Center.
To illustrate his point, Phipps refers to an informal survey he conducted among colleagues and peers, reporting that approximately half of the staff in the area's community mental health service system are smokers. In fact, there are staff members whose families own stores where cartons of cigarettes generate considerable weekly revenue.
"Most communities in Ohio have one or two of these obstacles-poverty, rural culture, tobacco industry," he says. "To have all three, they combine to create a major challenge to promoting new and healthy ways of thinking."
No Solo Flights: Small Pilot Project A Success With Follow-Along
In 2007, determined to beat the odds against tobacco recovery in his community, Phipps recruited some staff members to conduct a small pilot-cessation project. He found 19 interested mental health consumers. The results included the following:
- 6 people quit using tobacco altogether
- 9 people showed a significant decrease in tobacco use
- 2 people showed minor decreases in tobacco use
- 2 people showed little or no progress in decreasing tobacco use
He attributes the success of tobacco reduction and recovery to his staff members' regular, continuous follow-up with consumers. The more consumers were contacted, asked about their progress, and encouraged and motivated to replace tobacco use with healthy habits, the more they reduced their smoking.
Group homes and the sweat regimen
Phipps has targeted consumers who live in group homes as one of the populations for tobacco recovery follow-along services, because they are somewhat of a captive audience:
- they are easy to contact;
- they are close to the Shawnee Mental Health Center offices;
- and more than one consumer can be seen at each visit.
While group-home residents tend to be among the heaviest smokers-lighting up together provides opportunities for social bonding-Phipps has nonetheless found that such social dynamics can also be used to create and maintain healthy habits and wellness rhythms. Phipps himself has helped transform the smoke regimen into a sweat regimen by coordinating fitness programs (or workout groups) of two and three people.
Phipps has found another way to pique interest in tobacco cessation-via the American obsession with electronics. He acquired a compact carbon monoxide monitor to capture some informal baseline data from consumers: the device measures the amount of carbon monoxide in someone's lungs. It is a disposable, hand-held device about the size of an adult fist with a thumb-sized tube. Phipps explains that most non-smokers who blow into the tube register a reading of two while those who smoke regularly register double-digits. The highest he's seen is 82.
"Everyone loves gadgets," says Phipps, "and everyone wants to take the test. People started reacting to me coming around with the carbon monoxide monitor, and it's become a great way to get people involved." He explains that those who expressed interest in the gadget and took the test are now on his list of potential people to contact for his cessation program.
Let Flash test you
Phipps further explains that the gadget has a fifteen-second countdown during which a consumer is instructed to hold his or her breath. When the countdown ends, the detector lights up and chimes, and the person being tested is instructed to exhale into the tube.
"It amazes me how some people will almost always try to beat the system, even with smoking," Phipps laughs as he recalls discovering how several consumers sort of rigged the results of tests administered by staff members. The consumers were blowing into the detector so lightly that the device registered carbon monoxide with low, single-digit values, essentially fooling Phipps' staff into a delight over the consumers' seeming reductions in tobacco use. That's when a skeptical Phipps stepped in.
"I'd say, ‘Let Flash test you,'" he smiles and shakes his head, remembering his disbelief and explaining that he knew the consumers well enough to suspect they hadn't stopped smoking that much. So he would put his hand on the back of the detector and let the consumer know he was feeling for a full breath to exit the machine. The next breath often doubled the detector's reading of carbon monoxide.
Phipps is the type of person who bonds with others through humor, and the incidents of "cheating" have become a good story to tell and to laugh about. It's a lesson-learned from experience and he advises other service providers who want to use the detector to make certain that the person being tested is breathing through it with a full, regular breath.
Make Smoking Inconvenient
Flash Phipps became a smoker at the age of 13 and smoked regularly for the next 20 years. He understands the smoking mentality and, thus, feels a rapport with smokers and feels connected to consumers trying to quit.
"Even when I smoked, I never thought it was a good thing," he says. "By the time I found out how bad it was, it was too late. I was already addicted."
Phipps reflects upon the turning point in his smoking career-the epiphany. Although he was a heavy smoker, he refused to light-up in front of his children. Sequestered with his smoking habit, the hiding became so inconvenient that a ‘why-bother' attitude began ruining his ritual.
"That's one of the better ways to help a person quit smoking," he emphasizes. "Make it inconvenient."
Phipps has accumulated a few practical tips for cessation. "I tell people, put your cigarettes where they're not with you," he says. "Don't carry your cigarettes. Make yourself go through an active thing every time you need to get a cigarette. Don't keep them in your pocket. Keep them up in your room or put ‘em out in your car. Put them somewhere where you have to think about smoking. Because what we're finding is, if people have to think about their smoking, they won't smoke as much."
Matthew K. Weiland, MA, is senior writer, producer, and new-media specialist and Paul M. Kubek, MA, is director of communications at the Center for Evidence-Based Practices at Case Western Reserve University.