Case Study: How Implementation Science Helps Sustain State Tobacco Control Programs 

Do you remember the disturbing commercials highlighting the dangers of smoking cigarettes? One particularly chilling TRUTH (anti-tobacco campaign) used body bags to represent the 1,200 people who die from tobacco every day. Often aimed at adolescents, many of these campaigns have proven successful. According to a study published in the Ochsner Journal, the percentage of children under 18 who tried smoking at least once decreased dramatically from 1991 to 2021, from 70.1% to just 17.8%. 

National anti-tobacco campaigns aren’t new to media outlets. In the 1960s, pamphlets and magazine advertisements urging people to reconsider the dangers associated with tobacco use circulated throughout the United States. While 40% of Americans were regular smokers at the time, that number has dwindled to 20% in recent years, due largely to today’s high-impact anti-smoking ads on commercials and social media. 

Recently, tobacco control programs have relied more heavily on implementation science strategies to continue lowering the number of tobacco users in the United States. Today, we’re discussing three implementation methods scientists use to help support state tobacco control programs. 

#1 Incorporating Technology and EHR Integration 

Technology has advanced rapidly in the last few decades, and implementation scientists have leveraged this progress to benefit state tobacco control programs. For example, many states use tobacco quit lines, which are toll-free phone lines offering services to people trying to quit tobacco. However, many of those programs only impact to 1 to 2% of the adults who smoke each year. 

Enter the implementation of the Wisconsin Tobacco Quit Line’s eReferral system, which has increased the number of referrals to the state’s quit line. The eReferral system works as follows: 

1. Physicians use electronic health records (EHRs) to identify patients who are tobacco users. 

2. Providers use the EHR system to send automatic referrals to the Wisconsin Tobacco Quit Line. 

3. The system hands off patient information to the quit line. 

4. Quitline counselors receive each referral and contact the patients, providing tobacco cessation support. 

5. The quit line sends the outcomes of each referral call back to the EHR, updating the provider on the patient’s progress. 

Compared to clinics that sent fax referrals to the quit line, the eReferral system achieved a significantly higher referral rate. According to a case study on primary care implementation challenges and adaptations, the eReferral rate was 17.9%, while the fax referral rate was only 3.8%. 

#2 Implementing Evidence-Based Interventions 

With the help of implementation science, tobacco control programs can ensure their efforts are guided by evidence-based practices. By applying innovative research findings, these programs can adopt successful interventions tailored to specific sectors of the community. 

For instance, nicotine replacement therapy (NRT) aids tobacco users in quitting by delivering nicotine without the harmful chemicals found in tobacco products. Users can choose from various forms of NRT, such as gum, nasal sprays, sublingual tablets and transdermal patches. According to a study published in ScienceDirect, NRT can boost quitting rates by 50 to 70%. With such high success rates, NRT has been widely implemented across the United States to help decrease the number of tobacco users. 

#3 Increasing Stakeholder Engagement 

The tobacco industry spends 23 times more money promoting its products than states spend on their tobacco control programs. With fewer funds available to state programs, it’s essential to have the moral and financial support of stakeholders at the community, state and federal levels. 

From community members to policymakers, implementation science uses numerous strategies to involve stakeholders in planning, executing and evaluating each state’s tobacco control program. This approach aims to address the distinct needs of each community while also attracting additional donations and funding to support these initiatives. 

Expand Your Knowledge in Implementing Interventions 

Implementation science has been crucial in enhancing the effectiveness of state tobacco control programs, but its impact and potential extends far beyond this single intervention. Professionals in the field of implementation science contribute to a range of other health initiatives, aiding in their implementation and continued improvement. 

If you’re ready to advance your current role in health science, the University of Florida offers an online Graduate Certificate in Implementation Science designed for busy healthcare professionals. With an entirely online format, you can complete the 11-credit program at your leisure (and in as little as one year). Courses like Community Engaged Research for Clinical Effectiveness and Implementation Science Studies equip you with the skills to conduct healthcare research in collaboration with diverse community partners, much like the experts who work alongside the state tobacco control programs. 

Contact us with any questions, and when you’re ready to challenge yourself and advance in your career, start by filling out your application. 

Sources: 
https://www.ncbi.nlm.nih.gov/books/NBK294310/ 
https://www.ochsnerjournal.org/content/23/4/289
https://www.sciencedirect.com/topics/medicine-and-dentistry/nicotine-replacement-therapy
https://implementationsciencecomms.biomedcentral.com/articles/10.1186/s43058-022-00357-4