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Pieces of Eight


Quitters Find Support in Smoking Cessation Program

By Crystal Baity

Many of the smokers in the ECU Physicians smoking cessation program tried to stop on their own several times without success.

They‰ve quit and re-lit, switched brands, worn nicotine patches and chewed gum. Some even went cold turkey.

They‰ve found help through the ECU Family Medicine department‰s Fresh Air smoking cessation program. One participant calls it a non-judgmental and non-threatening support group.

,I haven‰t been able to say I‰ve quit yet,Š said Debi Crotts, 49, a Greenville graphic designer who recently completed the four-week program. ,It‰s a day-to-day thing. It‰s so hard. And that‰s why you need this kind of support.Š

The program‰s co-director, Dr. Sandra Hardee, pharmacotherapy specialist and associate professor in the family medicine department, calls Crotts once a week to see how things are going. As of mid-August, Crotts still wasn‰t smoking and was using a prescribed, cigarette-shaped nicotine inhaler to help her along.

cigarettes and lighters
Quitting tobacco often requires intensive, ongoing support, provided by ECU Family Medicine‰s Fresh Air smoking cessation program. (Photo illustration by Cliff Hollis)

,I think the habit is worse than the nicotine,Š she said. ,It‰s hard for a non-smoker to understand. It‰s an overwhelming urge that takes your breath away.Š For her, driving and talking on the phone were part of the smoking routine. For others, being around other smokers, eating a meal, having a drink, or dealing with work or school stress fuels their habit.

,These trigger points are really difficult and I think they take a long time to overcome,Š said Crotts, who started smoking occasionally in high school. Over time, she progressed to two packs of Vantage a day. She tried to quit several times and did pretty well for a while, but never remained smoke-free.

She‰s not alone.

About half return to smoking within the first three days of trying to quit, said co-director Dr. Hal May, a clinical psychologist and clinical professor of behavioral science in Family Medicine.

,Nobody thought ,this is the greatest thing I‰ve ever tried‰ when they started smoking,Š May said. ,They persist long enough for it to become a habit.Š

The program strives to give smokers the tools they need to get through the first step of withdrawal all the way through follow up after face-to-face meetings end. It begins with four sessions, one per weekday morning. At the beginning of each medical group visit, participants have their blood pressure checked.

Afterward, May, Hardee and two family medicine resident physicians cover topics like why people smoke, reasons to quit, barriers to change, behavior modification and nicotine replacement products. By the second week, an individualized plan for quitting has been developed for each participant, taking into account the patient‰s medical conditions and smoking behavior and assessments. The plan includes setting a quit date.

Going cold turkey only works for about two out of 10 people, Hardee said.

It worked for William Freeman, 57, a retired computer programmer and analyst from Washington who quit smoking eight months ago after completing the program. He began smoking in elementary school. Like Crotts, he had quit several times, once as long as two years. But he always went back to the cigarettes.

,I smoked in the office,Š Freeman said of his high-stress job. ,If the phone rang, before I picked it up, I would light a cigarette because I knew there would be a problem on the other end.Š

He also liked to smoke while playing cards. ,You‰re used to smoking while you‰re doing it.Š

He said deep breathing techniques have helped him more than anything as well as support from the group meetings.

,I‰ve been through it all,Š Freeman said. ,The gum tastes so bad I stopped doing it. The patches ‹ I had very vivid dreams and felt like when I woke up I hadn‰t been to sleep. It was just easier for me to quit on my own.Š

After retirement, Freeman wanted a change. ,This time I was ready. It‰s something I didn‰t want in my life anymore.Š

During a recent session, one participant said he only smoked when he drove his truck. It was his traveling companion, a stress-reliever and a pick-me-up while driving. He wants to quit because he is diabetic and wants to live as long as possible. Fresh Air is helping him succeed.

May and Hardee also are considering offering the program at night to accommodate people who can‰t leave their jobs to attend morning sessions.

In addition to serving patients, the Fresh Air program teaches family medicine resident physicians how to do group patient visits, which they will take into their own practice. The resident physicians are learners and caregivers in the program. Part of the Residency Training in Primary Care grant that funded the program start up was to help train residents in the group visit concept, May said. The grant was funded by the Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions.

In the first year of the program, 35 patients attended at least one session. Approximately one third, or 12, participants were successful in quitting. Although some relapse occurred, the program is committed to following all patients for a total of six months.

,Relapse is not a failure, but a learning opportunity,Š Hardee said.

Nationwide, there is about a 10 percent quit rate for smokers. Quitting means not smoking for six months or longer, Hardee said.

The program stresses individuality and proven approaches to quitting, supporting each person in their effort to stop smoking in a way that is right for them.

For more information or to sign up for the program, call 744-1358 or e-mail

This page originally appeared in the Sept. 2, 2005 issue of Pieces of Eight. Complete issue is archived at