​Dr. Michael Chin, Assistant Director of the Vanderbilt Occupational Health Clinic, talks about the prevalence of tobacco use and the best resources and strategies for quitting - including Vanderbilt's employee program Quit Rx.

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Bridgette Butler:  Welcome to this edition of the Vanderbilt Health and Wellness Wellcast.  I am Bridgette Butler with Health Plus.  I am here today with Dr. Michael Chin, Assistant Director of the Vanderbilt Occupational Health Clinic, and we'll be speaking about tobacco cessation and the best resources and strategies you can use to quit.  Welcome, Dr. Chin, and thank you for joining us today.

Dr. Michael Chin:  Thanks for having me, Bridgette.  Good morning.

Bridgette Butler:  Good morning.  So glad you're here.  Now, Dr. Chin, there have been encouraging reports over the last several years that tobacco use has been decreasing, yet it still remains a major health concern.  How prevalent is tobacco use at this time?

Dr. Michael Chin:  You are absolutely correct.  Across the U.S., tobacco use, smoking in particular, has been on the decline for the last 20 years or so.  Back in 2003, looking ... early 2000's, looking at about a 20% of the population smoking rate, and more recently, as of 2018, looking at about 14%.  So, there's been a dramatic decline over the last 20 years.

Bridgette Butler:  That's excellent.

Dr. Michael Chin:  Yeah, yeah.  The U.S. is definitely making progress.  I mean, obviously there's 14% of the population still smoking and given that there's a lot of preventable illness and death in that 14%, it's still 14% too many.

Bridgette Butler:  What are the health risks associated with tobacco use that are leading to some of those preventable illnesses and deaths?

Dr. Michael Chin:  Smoking, as many people know, is related to lung cancer, coronary artery and heart disease, and also, COPD.  So, smoking is actually the cause of 480,000 deaths per year.  That's approximately 1 in 5 deaths in the U.S., so about 20% of deaths.  It kills about 1 of every 2 people who actually use tobacco products.  And in terms of numbers, smoking causes 87% of lung cancer deaths, 32% of heart-related illness deaths, and 80% of deaths from COPD or chronic obstructive pulmonary disease.  So, obviously, still a lot of lives that could be saved in that remaining 14% of the U.S. that is still smoking.

Bridgette Butler:  Absolutely.  What resources are available to Vanderbilt faculty and staff to assist with tobacco cessation for those who do want to quit?

Dr. Michael Chin:  I would like to say, first, that Vanderbilt, both VU and VUMC, as a whole, have relatively low smoking rates, certainly compared to nationally, but even regionally, in terms of Tennessee.  Tennessee has relatively high smoking rates, higher than the national average.  It's around 20%.  But the Vanderbilt community, as a whole, it's around 4%.  So, 4%, you know, is still well under the national average right now of 14%, which is terrific.  That also means there are far fewer individuals probably looking, as a whole, looking for tobacco cessation, but we do offer our Quit Rx program here at the Occupational Health Clinic to help any employees, whether they are staff or faculty, to help guide them through the potential options for smoking cessation.  

Bridgette Butler:  That's wonderful.  And how would an employee take advantage of the program?

Dr. Michael Chin:  Basically, it's open to any employee, and all they need to do is just make an appointment with us, and actually, given the recent pandemic, many of these visits actually can be just done over telehealth or Zoom.  So, that's very convenient.  The program is nice because it's obviously, the visit itself is free of charge and included as part of a benefit of an employee at VU and VUMC, and the other part of it is that, given a lot of the advances in medical therapy for tobacco cessation, most insurance companies cover the cost of the medication, and one we use very frequently in clinic, once reviewing what the patient is interested in and you know, if they actually are a candidate for medical therapy, one that is very common for us to prescribe is Chantix, and this is something that many primary care offices also will prescribe.  In addition to that, there's other possibilities, some basic nicotine replacement therapy with patches, lozenges or gum.  That's another possibility.

Bridgette Butler:  Are there any other components of the Quit Rx program in addition to a visit with a provider at Occupational Health and potentially medication?

Dr. Michael Chin:  Sure, absolutely.  So, as part of the visit, a lot of it is about counseling, assessing ... the initial visit is all about assessing where the individual is in terms of their thought process and their readiness to quit and assessing that.  There are some further referrals that we could make, for example, other tools that might be helpful adjunctively, like mindfulness and what not, could be referred down to our sister department at Work/Life Connections or even at Health Plus.  That's a possibility as well.

Bridgette Butler:  So, it does sound like a great option for Vanderbilt employees, the Quit Rx program.  Do you have any additional strategies for those who are thinking of quitting at this specific time during the pandemic?

Dr. Michael Chin:  This pandemic is a really interesting time to be considering quitting smoking or tobacco cessation, generally, because, as you can imagine, people are extraordinarily stressed right now, and there is some preliminary data showing that there may be an increase, as one might expect, of smoking and tobacco product use.  Part of it may have to do with the added stress, but there is also some behavioral components, too, like being at home most of the time, therefore, not in environments where smoking is disallowed.  But there's also some interesting behaviors that we see with, for example, toilet paper, right, where in the early parts of the pandemic, people would go out and buy mass quantities of toilet paper and just hoard them.  Well, very similar kind of behavior has been reported, too, with cigarettes and tobacco products.  So, given a larger purchasing of these products and possibly stockpiling them at home and more time and more opportunity to use them definitely has added to the likelihood there is increased use during this time.  And then, on the other side of that, is this awareness toward, and generally speaking, for everyone, trying to stay healthy in the pandemic, especially lung health because COVID is an issue with the respiratory system.  So, you do have individuals who are smoking or tobacco users and becoming more motivated or more interested in quitting because of this.  One of the biggest issues, I think, in trying to quit, is something that quarantine has really made difficult, which is social support.  Having adequate amount of social support in quitting is really crucial and underestimated, I think, but in the course of the pandemic, obviously, we all have a very limited ability to connect socially.  So, that's probably the biggest challenge, I think, currently, for those who are really trying to make the effort.

Bridgette Butler:  And one recommendation I might have in order to increase their connectedness during this time is to watch the "Game Plan for your Health" video this year, step three of "Go for the Gold."  It's called "Connectedness:  Some Assembly Required."  Very helpful and it's even greater connection during this time.

Dr. Michael Chin:  That's a great segue there.

Bridgette Butler:  Well, this has been very interesting information and wonderful advice.  Thank you, Dr. Chin, for sharing your expertise on tobacco cessation and the Quit Rx program with us today.

Dr. Michael Chin:  Great.  Thanks for the opportunity, Bridgette.
 
Bridgette Butler:  Thanks for listening.  If you have a story suggestion, use the "Contact Us" page on our website at www.vumc.org/health-wellness.