Smoking Cessation

FAQ

What is 1-800-QUIT-NOW?

1-800-QUIT-NOW (or 1-800-784-8669) is the number that acts as a national portal to connect any smoker who is seeking assistance in quitting to the appropriate state telephone counseling quitline or to the National Cancer Institute quitline (in the event that their state doesn’t have a quitline) for free telephone counseling. This is a national initiative that is supported by the Centers for Disease Control and Prevention, the National Cancer Institute, and the North American Quitline Consortium. Telephone counseling quitlines are an evidence-based smoking cessation intervention that may be especially helpful to veteran patients who may be unwilling or unable to attend smoking cessation counseling because of their work, their disabilities, or because they would have to travel significant distances to their nearest VA. A referral or recommendation to a telephone counseling quitline should be coordinated by a VA provider with a prescription for nicotine replacement therapy or bupropion. Referrals to 1-800-QUIT-NOW should also be documented in the patient’s medical record as part of brief counseling. For additional information, please refer to the following links:

* External Link Disclaimer:
All the links marked with asterisk ( * ) are External links. By clicking on these links, you will leave the Department of Veterans Affairs Website. VA does not endorse and is not responsible for the content of the linked website. Links will open in a new browser window.

Smokefree.gov
http://www.smokefree.gov*

North American Quitline Consortium (NAQC)
http://www.naquitline.org/welcome.asp*

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Can we make our VA Medical Center smoke-free with no smoking on the grounds?

Currently, there is still a Federal Law in place requiring that VAMCs provide outdoor areas for veteran patients to smoke. This was a law proposed and enacted by Congress in the early 1990’s when VHA was moving to make all facilities smoke-free. Until Congress provides legislative authority for VAMCs to become smoke-free, VA medical centers cannot become completely smoke-free.

However, there is a lot that facilities can do to decrease exposure to secondhand smoke, such as decreasing the number of outdoor smoking shelters and making them less visible. Some facilities have been successful in reducing all but 1 outdoor shelter for patients and 1 for employees, as providing an area for employees has been part of collective bargaining agreements in some cases. It is important that smoking shelters be placed far away from the entrances to VA health care facilities for a number of reasons, including safety. In addition, those VA medical centers that continue to have indoor smoking areas for use by long-term care populations or inpatient psychiatric patients that were ‘grandfathered in’ as facilities were adopting smoke-free policies in the 1990s. Given that there is increasing evidence that the ventilation systems included in these indoor areas do not effectively remove hazardous exposures associated with secondhand smoke (see the 2006 Surgeon General Report), the use of these areas should be phased out as soon as possible and inpatients should be provided with nicotine replacement instead to prevent nicotine withdrawal.

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What can we tell VHA employees and staff who want assistance with smoking cessation?

There are a number of things you can do to help support your colleagues in VHA who are seeking information about how to quit smoking or using tobacco. Many smoking cessation specialty clinics have found ways to provide free, brief smoking cessation counseling to non-veteran employees, as long as it does not interfere with the care of veterans who are seeking help. In addition, some Employee Assistance Programs also provide smoking cessation counseling. While non-veteran employees cannot be prescribed nicotine replacement therapy or smoking cessation medications through VA pharmacies, VA canteens do have a national contract to buy and stock generic nicotine gum in their stores. So, VA employees can buy nicotine gum in many canteens at prices that are much lower than local retail outlets. Employees should also be encouraged to check with their insurance programs for information about coverage of smoking cessation treatment as a number of the Federal Programs provide some coverage of treatment. Finally, any employee who is interested in quitting should be referred to 1-800-QUIT-NOW, the national number that will link anyone interested in quitting to their state telephone counseling quitline for free counseling (see What is 1-800-QUIT-NOW?).

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What is the national policy with regard to pharmacy restrictions that require veteran patients to attend smoking cessation clinic before receiving smoking cessation medications?

There is no national policy requiring that veteran patients attend smoking cessation clinic before they can receive a prescription for nicotine therapy replacement (NRT) or bupropion. Previously, such a restriction was part of national policy, but this restriction was lifted in VHA Directive 2003-042 as it was inconsistent with the previous VA/DoD Clinical Practice Guidelines (as well as the 2004 Guidelines), and it was a policy that was not supported by the research evidence. Given that smoking is still the leading cause of preventable death and disease, it is important to remove any potential barriers to effective smoking cessation treatment. As smoking cessation medications, such as NRT, are an important part of evidence-based treatment, patients who want to quit using tobacco should have access to NRT. There is also no evidence to support the practice of limiting a patient to only one trial of NRT over the course of a year. Smoking is a chronic relapsing disorder and even the most motivated patients may attempt to quit 5 to 6 times before they are successful. For additional information about how to prescribe smoking cessation medications, please see the pharmacotherapy table under the Clinical Topics in Tobacco Cessation section.

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