Smoking cessation program provides hope for smokers living in Columbia Public Housing

[Thomas3.20.2010]

 After more than 40 years of smoking a pack and a half of cigarettes a day, Colton Dey does not look her age.

“I started smoking when I was 16 years old,” said Dey, a 57-year-old resident of Columbia Housing Authority's Oak Towers.

As she sat in the quiet fifth-floor library, Dey explained her need to finally kick the habit for good. She is among a handful of participants in a smoking cessation program facilitated by the housing authority and the Health Department. 

The initiative is funded by a $118,293 grant from the Missouri Foundation for Health awarded in August 2011. The grant provides funding for two programs to help people quit smoking: one for Columbia public housing residents and one for workers in local low-wage jobs. 

The first public housing smoking cessation classes started in January 2012. The grant was intended to fund concurrent six-week sessions in two public housing buildings, with free nicotine patches and support activities, said Linda Cooperstock, a health planner with the Columbia/Boone County Department of Public Health and Human Services. 

Nearing the six-month mark, the program has had few participants so far, and most of those who have tried to quit smoking have not succeeded. But cessation program coordinator Kimberley Nolty said the small team behind the program is tweaking it to make it most accessible for people taking on the daunting challenge of kicking nicotine. 

Nolty is a public health and social work graduate student who has been hired part time by the Housing Authority to coordinate all cessation activities. Her position assisting residents who want to quit smoking is funded solely by the grant. Her other responsibilities include running weekly support activities year-round at both Paquin Tower and Oak Towers, and coordinating the alternating six-week cessation programs with nicotine replacement therapy.

How it works

At first, Nolty divided her time teaching classes alternating weeks at Paquin Tower and Oak Towers in the same six-week period. 

"We found the first program was not quite supportive enough," Nolty said.

Residents reported at the end of the session that they needed more than one class every two weeks to succeed. 

Those observations helped shape the current program, Nolty said. 

Now, residents meet once a week in the facility where they live, either Oak Towers or Paquin Tower. They spend the first two weeks of class doing a multitude of activities in preparation to quit, Nolty said.  They are given a starter kit, including a journal, gum, mints and a straw approximately the size of an unlit cigarette to keep their hands busy.

They also learn from Nolty and a nurse how to approach quitting. Participants are required to keep a careful two-week record of their cigarette intake, and are asked to reduce tobacco use as much as they can. They record every cigarette they have in a log, including their mood and what they were doing at the time of their craving, and the strength of the craving on a four-point scale.

In the third week, it's time to start the nicotine patches. But before distributing them, a Health Department nurse measures the carbon monoxide in each smoker’s bloodstream.

Dey, formerly a pack-and-a-half-a-day Decade smoker, had 78 carbon monoxide parts per million in her blood stream. The average person has only one or two. 

The goal is to get all participants below two ppm by the end of the program.

“I hope it’s a lot lower,” Dey said.

The nicotine patches are key to getting people to show up. When they're not offered, Dey sits alone in a classroom.

Once they get the patches and learn how to use them safely, participants attend mandatory classes every Friday for the next four weeks, learning about nutrition, health, exercise and how to live without cigarettes. Nolty and the Health Department nurse share their wealth of knowledge about the impact of tobacco use on the body and help participants recognize the ways they're feeling better even while they're going through the agony of nicotine withdrawal.  

The participants are also invited to an optional support activity during the week. There's a tobacco-themed Bingo game, morning card games and coffee, progressive relaxation and "Afternoon Crunch" — a nutrition lecture with complimentary crunchy vegetables to temper oral and tactile fixations. 

A healthy obsession

For Dey, the healthy "crunch" of choice will have to be a banana. Next week, she'll have oral surgery to remove all of her bottom teeth. Eventually, she'll get dentures. She will save for her new teeth by setting aside money she used to spend on cigarettes — between $150 and $200 a month. 

A week after the oral surgery, Dey will have bladder surgery. 

It is imperative to her recovery process that she remain smoke-free. Nolty said upcoming surgery is often the factor that forces people quit smoking, even if attempts are not successful in the long term. 

Like others before her, the upcoming operations have made Dey ponder the state of her health and reconsider her life choices. She is extremely motivated to quit smoking for good.

Nolty said many people in the first session were able to quit for a short time, but picked the habit up againafter recovering from surgery.   

Dey has tried to quit at least four times before. This is not uncommon, Nolty said, because on average a smoker tries to quit seven times before he or she is successful.

Success rates for the program are not officially available through the Health Department yet — they still need to do follow-ups and formal analysis — but Nolty, who has been with participants every single week, has preliminary numbers. 

In the first six-week trial program, where participants were spread across two locations, two of 14 participants are still smoke-free today. 

Nolty said five people were enrolled from Paquin Tower and nine were from Oak Towers. The Health Department declined to confirm the success rate, though Cooperstock said she's happy with the program and the partnership between the Health Department and Housing Authority.

Though the numbers may seem low, Nolty said she expected a program success rate of about 15 percent. 

"The average success rate of a person who quits smoking cold turkey is about 7 percent," she said. "When they use nicotine replacement therapy, their success rate almost doubles, to 12–15 percent." She tries to keep her expectations realistic because nicotine addiction is so strong. 

Oak Towers only had a success rate of 11 percent, while Paquin had a success rate of 20 percent due to a smaller sample size. 

A smoke-free environment

Dey lives on one of two smoke-free floors in Oak Tower. Resident Services Coordinator April Steffensmeier explained that residents are still allowed to smoke inside on five floors of the public housing building. 

In Paquin Tower, three floors, common areas and hallways are smoke free. Smoking is allowed on 10 other floors.  Steffensmeier said managers work to move people to the area they would prefer to live.

“Over the past year, managers have been transferring people in both directions,” she said.

Cooperstock would like to see all public housing smoke-free eventually. She believes people who do not want to breathe secondhand smoke are entitled to a completely smoke-free environment — regardless of their income or status as a public housing resident.  

According to 2009 literature review published in the peer-reviewed Nicotine & Tobacco Research journal, research has found that people who live in smoke-free environments are 50 to 70 percent more likely stay cigarette-free than people who live in places where others still smoke.

Further, according to the researchers, "studies consistently found complete home smoking bans appeared to be beneficial, while partial home smoking restrictions showed little or no effect."

Cooperstock said though many would support smoke-free public housing, the housing authority has seen some backlash to the smoke-free policies from smokers who feel discriminated against, which is why buildings have not been designated nonsmoking. 

However, Cooperstock does not believe smokers can take a non-smoking movement personally. “Smoking is not an inalienable right,” she said. "You can change your status as a smoker. You can quit." 

Still, the smoking cessation program runs on a voluntary basis; it's only intended to help individuals with limited resources quit smoking. The task of overcoming nicotine addiction is notoriously difficult even for those who can afford to quit with the assistance of a physician. 

No one living in public housing will be forced to quit, Nolty said, because that would be a waste of resources. “You can’t help someone stop smoking unless they really want to quit,” she said. 

What it's like to quit

Bob Turner, 67, is also in the cessation program with Dey. He is counting on the program to improve his quality of life.

“I feel better since I’ve quit,” he said. “I breathe easier. The heat doesn't affect me as much. and food tastes a lot better.”

To this, Dey nodded in agreement. “I’m starting to notice — there was not much taste before,” she said. 

For two years, her favorite relaxation spot has been on her couch: her right hand hovering over an ash tray and her left hand stroking her eight-pound Maltese, Rainbo. Though she still keeps the cigarette-sized straw from the starter kit in the crook of her lips, she no longer has to worry about burning her dog with the lit cigarette, or dropping ashes on him. 

Her dog is happier. “My dog really likes me not smoking because now I have two hands to pet him,” Dey said.

Turner and Dey agree that the smoking cessation program is helpful. “It’s a good program – I’m glad we have it,” Dey said. “I breathe so much easier. You think, ‘Hey, I should have been doing this in the first place!’” 

Turner agrees, but unfortunately this is his third attempt working with Nolty to quit. He says he has probably seriously tried quitting seven or eight times. 

“I’m confident this time will work – that’s the way you have to look at it,” he said.