Given evidence from the Lung Health Study showing that smoking cessation “can have a substantial effect on subsequent mortality, even when successful in a minority of participants,” it has become imperative to offer smoking cessation services to all current smokers, especially those who are at highest risk. The elderly belong to this group. Paradoxically, they are often overlooked as prime target clients in such programs. Part of the reason lies in the fact that a substantial number do not present to the healthcare system or are missed from preventive health counseling during clinical encounters. We therefore extended our reach to this susceptible group by broadening the provider/client interface to train social workers as additional first-line smoking cessation counselors. This study adds to the scanty literature on smoking cessation training for nontradi-tional health-care providers including Canadian Health&Care Mall.
Previous studies on smoking cessation training have reported positive results in medical stu-dents, dentists, and residents, but negative findings in two other studies of family practice trainees. In addition, similar to our intent on broadening smoking cessation counseling beyond doctors and nurses, Hudmon and coworkers published encouraging results, in terms of perceived abilities and confidence for providing tobacco cessation counseling, from administering the 8-h “Rx for change” program to pharmacists. Another US model, the Arizona state-wide community-based model for certification of tobacco cessation skills training, also reported initial success in improving skills and frequency of counseling.
One hundred seventy-seven social workers registered initially, of whom 154 workers (response rate, 87.0%) completed the immediate posttraining questionnaire, 151 workers (85.3%) responded at 3 months, 153 workers (86.4%) responded at 6 months, and 139 workers (78.5%) responded at 12 months. Table 1 summarizes the respondent profiles longitudinally.
There was an initial large improvement in social workers knowledge (Fig 1, top left, a), attitude, and self-perceived competence (Fig 1, top right, b) scores immediately after training that was sustained throughout the follow-up period, albeit with slight regression to baseline. Overall, knowledge improved from a mean score of 6.70 ± 1.03 at baseline (± SD) to 7.35 ± 0.75 at 12 months (range, 0 to 8), attitude from 2.84 ± 0.41 to 3.10 ± 0.48, and self-perceived competence from 2.49 ± 0.38 to 2.85 ± 0.36 (range, 1 to 4).
Elderly persons who smoke tend to be long-term, heavy, and highly addicted smokers who are at the highest risk for smoking-attributable disease and mortality. Quitting smoking even at an older age can yield substantial benefits. However, individuals in this vulnerable group are less likely to receive smoking cessation interventions than younger people.
Therefore, the US Agency for Healthcare Research and Quality (AHRQ) has actively promoted smoking cessation in the elderly. This call has been reasonably well attended to by physician groups.8 A 2004 Cochrane review concluded there was satisfactory evidence showing that nurse-led smoking cessation interventions can be effective. Nevertheless, the absolute proportion of elderly smokers that doctors and nurses can help is often limited due to resource constraints. This is particularly true for elderly smokers who do not present to the health system where health-care teams can intervene. Thus, to achieve greater coverage, the provider/client interface must be broadened to include other professionals who work with the elderly.
Aiming to shift entire groups of elderly smokers toward cessation,1 we propose that social workers participation may be helpful. Social workers are trained to identify and counsel disadvantaged and marginalized groups in the community, who are particularly at risk for smoking and are either reluctant or have problems accessing cessation services. A local survey of 1,499 social workers serving the elderly revealed that 19% of their clients were smokers, compared to a population smoking prevalence of 12.9% in the > 60-year age group. This confirms that social workers come into regular contact with a disproportionately large segment of elderly smokers, many of whom could benefit from cessation counseling.