Public
HealthPublic
Health
By Bill Case
The author is manager of news services at
WVU's Robert C. Byrd Health Sciences Center.
Stand outside almost any high school or office building in West Virginia, and you'll smell it: the stale odor of tobacco smoke. Look down. Chances are, you're standing on a cigarette butt.
At WVU's Robert C. Byrd Health Sciences Center, health professionals are working with smokers and chewers-and with teachers, counselors, doctors, dentists, and others—to find solutions to the state's most serious health problem.
"West Virginia is number one in adolescent cigarette use and number one in adolescent smokeless tobacco use. We're in the top two or three in adult use of tobacco products," says Elbert Glover, Ph.D., director of the Tobacco Research Center at WVU's Mary Babb Randolph Cancer Center. "Altogether, I'd say we've got the worst tobacco problem in the country.
"We've specifically zeroed in on cessation," says
Dr. Glover. "People call us to see what really works for
the patient who wants to quit."
WVU's Tobacco Research Center has tested more nicotine drugs than any other center in the country, he says. "We've conducted studies with nicotine patches, gum, nasal spray, oral inhalers and tablets, and with antidepressant medicines which can help people quit."
The strength of the program, he says, is its continuing work with nicotine-addicted patients. "We've helped thousands of people quit. I see them in the grocery store, or in the line at the movie theater, and they come over to say they're still not smoking."
Glover travels the state and the nation to recruit health professionals to the fight against smoking. In dozens of talks around West Virginia each year, he encourages doctors to ask patients about their tobacco use. "Smoking status should be viewed as a vital sign, just like blood pressure and temperature: a basic question you ask every patient. Once the conversation is started, then you can motivate the patient to change. It's the very best thing a doctor can do for a patient's health.
"Helping someone stop using tobacco is very complex and labor-intensive for physicians," he says. "It's an addiction—just like heroin. There are drugs that can help, but the patient must want to quit."
Glover, who participated in early clinical trials of antidepressant treatments for smokers, says they offer new hope for some patients and doctors who resisted the nicotine products. "The nicotine products work: we've conducted research that confirms this. But a lot of people don't want to prescribe or use more of the substance that is the cause of the addiction. The important thing is to get people to quit."
WVU's Prevention Research Center has long worked with West Virginia public schools and the Bureau for Public Health. Together, they developed a tobacco and other drug prevention program called "CHOICES" which has been introduced in 20 counties. Now, the expertise of the center is going nationwide.
Faculty members Geri Dino, Ph.D., and Kimberly Horn, Ed.D.,
were selected by the American Lung 
Association
to develop the group's new program to help teen smokers quit.
"Not On Tobacco"—known as N-O-T —is currently
being tested in schools in West Virginia and Florida. The association
hopes to have it in place across the country later this year.
"The association gets calls every day from teachers, school counselors, nurses, and others who work with teenagers, looking for help developing a curriculum to help the kids who want to stop. We hope this can be it," says Dr. Dino.
N-O-T is about life skills, in addition to quitting smoking. It's a nine-week program conducted with small groups of teenagers. Males and females participate in separate sessions with a same-sex facilitator.
"We focus on total health, not just smoking," says Dr. Horn. "Teens are more willing to talk about the whole range of health issues—nutrition, fitness, stress management, decision-making -in a small, single-gender group."
By testing the program in urban and rural schools, and in different cultural groups, the pair hope to develop a system flexible enough to be adapted to schools across the country.
But Horn warns that there is "no quick fix" for teen smokers. "It's a very complicated problem, and no one expects that one approach will work for every teenager."
Responding to the needs of each community is important. "The way we have always worked is to en to the needs of community practitioners, develop tools that they can use, and put them back into the hands of the community," says Horn.
West Virginia dentists are using new technology-and old-fashioned common sense-to take on smokeless tobacco in the state's elementary and secondary schools.
"We're teaching all of our dental students to ask patients
about tobacco, to give users a strong message to quit, and to
reinforce the decision of non-users to stay off tobacco,"
says Richard Meckstroth, D.D.S., of the dental practice and rural
health program in the WVU School of Dentistry.
But that's not enough. Students also learn to use an inside-the-mouth TV camera to spot early signs of cancer. "They take this out to schools and other places, and ask the tobacco users to take a look at the insides of their mouths on the TV screen. Seeing those precancerous patches growing on their own tissue is very effective in motivating kids to quit."
Dr. Meckstroth says the School of Dentistry hopes to involve all the state's dentists in an all-out push to educate patients about tobacco and motivate them to quit.
WVU dentists are also taking the lead in providing schools and parents with information about chewing tobacco and snuff. Early this year—following a suggestion from Kathy Helmick, a Randoph County public health nurse—the "Through With Chew" program provided 450,000 newspaper readers in West Virginia with a four-page tabloid about smokeless tobacco. It included graphic color photos of the faces of tobacco users who had been stricken with oral cancer.
"We had an overwhelming response," says Meckstroth. "In the very next week we had orders for 50,000 reprints from schools, primary-care centers, health departments, and others."
The handout had the intended effect on at least one WVU staff member, Meckstroth says. "His daughter saw that in the paper, and went right over to him and asked him to quit. She cried. She didn't want that to happen to her dad. And he quit."
"I believe a smoke-free society is coming as sure as the
sun is coming up tomorrow." This is the prophecy of Patrick
Reynolds, a former pack-a-day smoker who is on a crusade to convince
lawmakers to increase sales taxes on cigarettes, strengthen tobacco
industry regulation, and limit or eliminate tobacco advertising.
Ironically, Reynolds is the grandson of tobacco mogul R.J.
Reynolds, whose North Carolina-based company—
number two in the tobacco industry behind Philip Morris—manufactures
one of every four cigarettes sold in the U.S., including leading
brands such as Winston, Salem, and Camel.
After watching his grandfather, father, and oldest brother die of tobacco-related emphysema and lung cancer, Reynolds said, he sold his tobacco company stock and joined the anti-tobacco movement. His Foundation for a Smoke-Free America is credited with helping secure a 25-cent per pack tax on cigarettes in California.
Reynolds, on campus as part of the WVU Festival of Ideas lecture series, told his audience that in 1997 the tobacco industry spent $30 million to influence Congress and even more to influence state legislators. "This has to be stopped before reforms can be made," he said.
Americans, he said, live in a society that encourages addictions to things which held them escape pain—one of these being tobacco. He reviled tobacco advertising that he believes targets children and teenagers, such as the controversial Joe Camel campaign.
He praised the Monongalia County Board of Health for attempting last year to ban smoking in all public places, including restaurants. "Bring it back," he said of the failed legislation. "It's not such a strange idea."
—Becky Lofstead
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