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October is Healthy Lung Month

Image of Margo KerriganMargo Kerrigan, M.P.H., Area Director
Indian Health Service California Area Office

October is dedicated by the American Lung Association as Healthy Lung Month. Nationally, commercial tobacco use is the chief preventable cause of illness and death in our society, responsible for more than 430,000 deaths in the United States each year.1 Smoking is a known cause of cancer, heart disease, stroke and chronic obstructive pulmonary disease (a chronic lung disease that includes emphysema and bronchitis). Chronic lung disease and lung cancer contribute to almost half of the deaths from cigarette smoking each year. Still, even with high public awareness of the dangers that commercial tobacco presents, tobacco use is surprisingly widespread. In 2004, over 20% of US adults smoked cigarettes.2

Approximately one of every three American Indians and Alaska Natives smoke, including almost 38% of men and 27% of women. This is the highest rate of smoking prevalence among all adults of all ethnic and racial groups.3 The American Indian population also has the highest prevalence of smokeless tobacco use. Fourteen percent (14%) of American Indian males and two percent (2%) of American Indian females use smokeless tobacco, as compared to about 6% of males and .01% of females in the general population.4

More than 70% of smokers report that they want to quit smoking.5 However, only half of all smokers seeing a primary care physician in the past year reported being asked about their tobacco use and advised to quit.6 The National Cancer Institute estimated that if physicians assisted 10% of their patients who use tobacco in quitting, 2 million more people would stop using tobacco each year.7

Delivering a stage-appropriate "Five A Model" (Ask, Assess, Advise, Assist, and Arrange) brief intervention can potentially increase a patient's likelihood of quitting tobacco by at least 60%.8 The structure of the Indian Health Service healthcare system provides the unique opportunity for healthcare teams to develop a "tobacco intervention system". A brief intervention with a tobacco user does not need to lie solely in the hands of the physician. Any provider can Ask about tobacco use while taking vital signs, and document the results at every visit. During the visit, providers can both Advise to quit and Assess of the patient's readiness to quit. Assisting with treatment and Arranging for follow up will vary based on local protocols and available resources.

Government Performance and Results Act (GPRA)

The Indian Health Service has a GPRA measure for tobacco cessation intervention. This measure calculates the percentage of tobacco-using patients who are offered cessation intervention (counseling) within the previous year. During FY 2006, the first year of this measure, 12% of tobacco-using patients were offered counseling at all IHS Areas. In California Area, the FY 2006 rate was 9%. In FY 2007, the national rate increased to 16%, and the California rate increased to 11%. The Clinical Reporting System (CRS) also tracks the percentage of patients identified as tobacco users, broken down by gender and age groups.

Other Initiatives

In 2006, the Indian Health Service announced the Director's Three Initiatives: Health Promotion and Disease Prevention, Management of Chronic Disease, and Behavioral Health. As these initiatives begin to unfold, it is evident that tobacco control has a key role in the improvement of the health for AI/AN people. The IHS Tobacco Control Task Force has recognized this crucial opportunity and has developed a strategic plan for tobacco control within the context of Indian Health Service and Tribal Health facilities. The mission of this multi-disciplinary team's strategic plan is similar to that of the Director's Three Initiatives: In partnership with American Indian and Alaska Native people, raise their physical, mental, social, and spiritual health to the highest level possible through the prevention and reduction of tobacco-related diseases. An important component of this plan is to develop models for tobacco-cessation clinics that are self-supporting, integrated into clinic processes, and that can be easily adapted to different health care settings. With help from the American Legacy Foundation, this comprehensive systems approach to tobacco cessation and prevention in tribal clinical systems is underway.

The Clinical Tobacco Control Fieldbook: "Implementing Tobacco Control into the Primary Healthcare Setting" is one project close to completion. The fieldbook is designed to meet all levels of tobacco treatment in the primary healthcare setting by providing healthcare providers with an all-inclusive reference, which will include evidence-based materials, successful training programs, patient treatment programs and patient/clinician materials. It has a concrete framework based on the US Public Health Service Clinical Practice Guidelines with adaptable ideas and materials. If you have any questions regarding the IHS Tobacco Task Force please contact, LCDR Megan Wohr, megan.wohr@ihs.gov.

Other resources:

American Cancer Society: "Guide to Quitting Smoking" http://www.cancer.org/docroot/PED/content/PED_10_13X_Guide_for_Quitting_Smoking.asp Exit Disclaimer – You Are Leaving www.ihs.gov

National Cancer Institute: "Prevention and Cessation of Cigarette Smoking" http://www.cancer.gov/cancertopics/pdq/prevention/control-of-tobacco-use/patient/ Exit Disclaimer – You Are Leaving www.ihs.gov

National Institute of Health/National Cancer Institute: http://www.smokefree.gov/ Exit Disclaimer – You Are Leaving www.ihs.gov

American Heart Association: "How can I quit smoking?" http://www.americanheart.org/downloadable/heart/110288043796734%20HowCanIQuitSmoking.pdf (PDF 43KB) Exit Disclaimer – You Are Leaving www.ihs.gov

Centers for Disease Control: http://www.cdc.gov/tobacco/quit_smoking/you_can_quit/index.htm Exit Disclaimer – You Are Leaving www.ihs.gov

1Fiore, et. al. 2000
2CDC, 2006
3CDC, 2006
4Hodge, Frederick, Kipnis, 1999
5Fiore, et. al. 2000
6Goldstein et. al. 1998, Robinson et. al. 1995
7Fiore et. al. 1990
8Fiore et. al. 2000

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