Strategies to enhance adult tobacco cessation program outcomes in a public healthcare network

Since January 2003, the Health Federation of Philadelphia has partnered with Philadelphia's Department of Public Health Tobacco Control Program and Ambulatory Health Services to provide adult tobacco cessation services at eight District Health Care Centers. In addition to offering on-site cessation groups and dispensing free Nicotine Replacement Therapy to patients, the program includes developing protocols for patient referral and training clinicians in the “5 A's .” Program results have been positive, with more than 900 participants enrolled to date. Nonetheless, group participant retention poses a considerable challenge to effective cessation service delivery: those completing the program experience significant smoking reduction (mean reduction rate of 10.91 cigarettes, 2003-5), but historic program retention rate has run between forty and fifty percent in this resistant population, which includes segments disproportionately targeted by “Big Tobacco.”Since 2005, in addition to quantitative data, we have collected and evaluated qualitative clinician and consumer feedback, anticipating and now leveraging the 2006 enactment of Smoke Free Philadelphia legislation. From this base we have designed and implemented innovative approaches to cessation service delivery; these and their outcomes will be presented in a case study.