Program trains treatment specialists to help ‘persistent smokers’ quit; providers encouraged to get trained, not give up on them

By Melissa Patrick
Kentucky Health News

A program offered by the College of Nursing at University of Kentucky is training tobacco-treatment specialists with evidenced-based information, and developing the skills needed to help smokers quit, especially “persistent smokers” who have struggled to stop. About one in four, or 23 percent, of Kentucky adults are smokers, according to the latest Kentucky Health Issues Poll.

“I don’t think anyone would challenge the idea that there are certainly sub-sets, and probably pretty large sub-sets, of tobacco users that require this more intensive type of approach or intervention,” said Ellen Hahn, a UK nursing professor and a leading tobacco-treatment advocate. “We spend time discussing motivational counseling, meeting people where they are, and understanding what their environment is like. We train tobacco counselors to use those skills in these more challenging populations.”

For a slightly larger, clearer version of the poster, click on the image.

Hahn runs BREATHE, which stands for Bridging Research Efforts and Advocacy Toward Healthy Environments. Among other things, BREATHE advocates for smoke-free ordinances and other policies to promote healthy environments.

She and course director Audrey Darville said the TTS training is recommended for anyone who is looking to work with people to help them quit smoking, including, but not limited to, doctors, nurse practitioners, physician assistants, pharmacists, community health workers, people who work in health departments and hospitals, substance-use counselors, quit-line counselors and health coaches.

Kentucky’s TTS program is one of 19 such programs in the world. Since it became accredited in August 2017, it has trained more than 150 new specialists, said Darville, an associate nursing professor at UK.

BREATHE’s online training to become a tobacco treatment specialist, or TTS, is a 27-hour, self-paced program that generally takes between eight and 10 weeks to finish and costs $800, with a few scholarships available to people in Kentucky. Upon completion, participants earn a training certificate, which is the first step in obtaining an optional national TTS certification.

Darville said it’s important to focusing on “treatment” instead of “cessation,” saying there is a “subtle bias” between using the phrase “tobacco cessation,” which places the onus of responsibility to quit on the person trying to quit, and “tobacco treatment,” which recognizes tobacco use as an addiction.

“It’s helpful for us to start thinking collectively about this as a treatable addiction,” Darville said. “Most people try to quit on their own and five out of 100 people can do that, or less. Most people need help; they need treatment.”

Darville said tobacco treatment is offered through counseling or medication, and smokers who are most successful at quitting are the ones who participate in both at the same time. Depending on the intensity of the combined treatments, Darville said success rates can be upwards of 60 percent.

Hahn added that it often takes a person many attempts to “stay quit,” even with intensive therapy, “so you’ve got to try and try again.”

The training doesn’t teach electronic cigarettes as a way to help persistent smokers quit, Darville said, because “there is no clear evidence they help, and some evidence that recommending these devices may lead to dual use, with increased toxicant exposure, and delay quitting.” Further, she said, until the U.S. Food and Drug Administration regulates them, it is impossible to know exactly what they would be recommending, since more than 400 types of unregulated e-cig devices are on the market.

“Hopefully with FDA regulation and more studies we’ll get a bit more precise in our ability to discuss the potential benefits/risks of use for cessation,” she said. ” We’re simply not there yet, and likely won’t be until FDA regulations take effect in 2022.”

Darville and Hahn announced in the interview that have received a university grant that will allow them to offer a graduate level version of the TTS program. Graduate students in the program will gain college credit and a graduate certificate. “We are the only ones who are doing this,” Darville said.

To the smokers who want to quit, Darville said, “You don’t have to do this alone. Most people benefit from getting help. So have a conversation, seek help, there is great coverage out there. Just ask, reach out. ”

And to the providers, she said, “Have this conversation with your patients who use tobacco. Don’t give up on them. It’s a process. And if you feel like you are frustrated with it, get trained. Learn more and develop the skills that are evidence based to help you feel less frustrated.”

Click here for more information on the TTS program, which is now enrolling for courses starting May 1 and July 10.

Kentucky offers a free program to people who want to quit smoking called Quit Now Kentucky, which can be found at or by calling 1-800-QUIT-NOW (1-800-784-8669). Many health departments also offer free or low-cost smoking cessation/treatment programs.

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