St Luke’s Hospital in Maumee, Ohio, serves its community with an effective smoking cessation program for students at various grade levels, including an alternative to a suspension program for teens.

For nearly 100 years, St Luke’s Hospital, Maumee, Ohio, has distinguished itself by serving its suburban Toledo community. So it was no surprise when, 7 years ago, a local high school principal turned to St Luke’s to help him solve a community problem—teenage smoking.

The school kept suspending students who had been caught smoking, but the principal saw that this was not curtailing the problem. “The principal called us to see if we had [a program], and at the time we did not, so it kind of started out on a one-to-one basis with the kids as they needed it,” says Holly Kowalczk, RRT, nicotine dependency educator at St Luke’s. After a successful trial year, the program, christened with the catchy title Don’t Be a Nico-Teen, has become part of the lives of students at 28 high and middle schools in 11 school districts in and around Maumee.

In addition to its long tradition of public service, medical realities make sponsorship of the program a natural fit for the not-for-profit St Luke’s. “[About] 50% of the people in this hospital wouldn’t be here except for tobacco,” says Debbie Matthews, RRT, RCP, pulmonary health and rehabilitation supervisor at St Luke’s. “I think as far as the hospital is concerned, they would like to see more people be healthier. There will always be a need for hospitals, but we would like it to be for something that wasn’t the patient’s fault.” There are 48 respiratory staff members at the 314-bed hospital. Services include a full gamut of offerings including pulmonary rehabilitation and adult smoking cessation programs.

Four St Luke’s staff run Don’t Be a Nico-Teen, which costs between $75,000 and $100,000 per year. Funding comes from both the hospital and community groups and partnerships.

Holly Kowalczk, RRT, nicotine dependency educator at St Luke’s.

Wide Age Range
The Don’t Be a Nico-Teen program is far- reaching, designed to appeal to kids at various points in their academic careers. In addition to classroom presentations for the younger and middle grades, the program appears at school health fairs, “so the kids get used to seeing us,” says Kowalczk.

An alternative to a suspension component geared to teens includes an education behavior modification curriculum. It consists of two 3-hour Saturday sessions. Kowalczk and her colleagues see the program as an intervention, but are realistic that few of the participants are interested in quitting. “They’ve been caught at school using or possessing tobacco products, and in lieu of suspension, they come to see us,” she says. “We do tobacco education at that time. We have guest speakers. One of our goals when we see kids in our Saturday group is to get them interested in wanting to quit, so we try to move them along those levels of change.” The suspension alternative receives about 300 referrals per school year. Participants are evenly split between boys and girls.

The third aspect of the program is the voluntary 8-week Tobacco Awareness Program (TAP) designed for those students who want to quit smoking. It is held 1 hour a week during the school day.

Kowalczk and her colleagues also take their tobacco cessation message directly to the students in lunchroom education sessions that are used to sign up kids for TAP. The strategy has been successful, with one noteworthy session netting 29 students.

Peer Pressure
Teenagers themselves are enlisted to get the word out about the dangers of smoking. The Stay Tobacco Free Athletic Mentor Program (STAMP) uses high school students—both athletes and nonathletes—to bring the message of staying smoke-free to local sixth graders. It is a program that creates instant rapport with the junior high students. “We have the high school kids going into the middle schools delivering the same message we would say, but would go in one ear and out the other,” says Kowalczk. “We have the cool high school kids coming over, and they hang on every word. The message is you can be cool, you can be like me, and I don’t smoke, so you have a cool wannabe peer delivering the message. These kids are kids that sixth graders want to be like.” Last year, 17 students were signed up as mentors. This year there are 63, including all 17 mentors from last year.

St Luke’s also sponsors special programs during the annual Great American Smokeout in November. These have included addresses by RJ Reynolds Tobacco heir Patrick Reynolds and former Winston Man Dave Gerlitz—the latter went to three schools a day for 5 days, bringing his story to more than 7,000 students. Most recently, the high school students held a mock tobacco trial at the city courthouse that attracted local media and spectators. St Luke’s also has sent students to Columbus to help lobby lawmakers to pass antismoking legislation.

Follow-Up
The successes of the smoking cessation programs are measured throughout the year. After the students complete the alternative to suspension program, St Luke’s surveys them at a 1- to 3-month period and on their 1-year anniversary mark. The surveyors have found that 28% of these students self-report that they have quit smoking. More impressive is the quit rate for the TAP program—40%—which is a scientifically measured and validated statistic.

Matthews credits the hospital as key in the success of the antismoking efforts. “The hospital’s philosophy is that we are committed to our community and that follows through to the staff, and our staff is dedicated to the community,” she says. “Our staff really take that out there, and they’re dedicated to improving the community. I think the community understands that and appreciates that.”

Perhaps the most remarkable aspect of the growing Don’t Be a Nico-Teen program is that St Luke’s does no direct marketing of it. “We’ve done a nice job, I think, in getting the local TV stations to support the program,” says Dave Dewey, vice president of information and marketing services. “Being a system geared toward the schools, and that’s really the referral source, it can be successful without advertising. We’ve picked up a lot of good, positive word of mouth just because the local media has recognized that it’s a good program. It’s doing good work. [And] it’s our longer-term perspective. St Luke’s is going to be here 10, 15, 20 years from now, so if we provide a community education program that is very positive to someone, in 10 years when they need something done, they might say, ‘You know I might try St Luke’s.’ ”

The most important marketing tool at Dewey’s disposal is the staff, who, reflecting the friendly community-focused tradition of the hospital, spread the message in an enthusiastic, positive manner. “Any time I can get a community member involved with one of our staff, they sell St Luke’s just because of the job they do,” says Dewey. “And I think that’s probably the best advertisement, word of mouth.”

Challenges
With all the program’s success and support, challenges remain. “The schools have different needs and goals than we do,” says Matthews. “They want to educate their students. They want them to graduate. They want them to pass their proficiency tests. We want them to make healthy lifestyle choices. Not that [the schools] don’t want them to, but that’s not their primary goal. We need to go in there and make sure that they understand how we can help them accomplish their goals.” According to Matthews, tobacco can lead to the use of other drugs, and can impair concentration, subverting the school’s goals in addition to negatively affecting the health of the student. Recent studies have shown that about 90% of smokers get hooked as teenagers.

Every summer, the Don’t Be a Nico-Teen program is reevaluated, and elements are added, such as t-shirts or new logos. But new ideas are implemented only if something has stopped working. “Basically, it will change if it needs to change,” says Matthews.

The constant reinvigoration of Don’t Be a Nico-Teen is necessary, she notes, citing organizations such as Mothers Against Drunk Driving (MADD) that have been less active in recent years and have seen their gains erode. “I think it’s like all the other drugs—they’re always going to be there,” she says. “It’s going to have to be a continual fight.”

C.A. Wolski is a contributing writer for RT magazine.