Joanne Ursini didn’t need help from a nicotine patch or stick of chewing gum to quit smoking. She could just stop, whenever she wanted to, even after having smoked off and on for 35 years.
“But I always started again,” said Ursini, 65, a 23-year Yale Hospitality employee who works in the dining hall at Davenport College. “After awhile something is so addictive that you don’t look at the reason behind doing it. I just always went back. I knew my capabilities (to quit). I just never committed myself to stopping.”
That changed when she met Lisa Kimmel, MS, RD, and Krysten Bold, PhD. The two women, along with other wellness experts and researchers at Yale, had developed a new workplace-based smoking cessation program they thought could help Ursini and her food service colleagues kick the habit for good.
As opposed to passing out stop smoking pamphlets or inviting workers to an offsite meeting where they could be counseled about quitting, the researchers proposed to bring nicotine replacement therapy like patches and gum and nurse counselors right to the dining hall so employees who smoked could get free treatment at work.
Ursini was skeptical but decided to give the program a try because she really did want to stop, and she believed Kimmel, Bold, and the other members of their team genuinely wanted to help her.
Plus, she liked the idea of being paid a small cash incentive by the researchers to try to quit.
“We care about our employees’ health and well-being and want to create an environment where tobacco users are supported in their quit attempts. And while we’ve traditionally offered (smoking cessation) programs at other places around the university, our goal was to bring this program directly to our hospitality employees in the dining halls,” said Kimmel, a registered dietitian and certified nutritionist, and Director of Wellness and Health Education for Being Well at Yale.
Yale has long been at the forefront of Ivy League institutions in offering its students and employees programs to quit smoking and stay tobacco-free. On March 6, 2018, the university adopted a policy that prohibits the sale or use of tobacco-derived products on all indoor and outdoor university properties. Students, faculty, and staff have access to nicotine replacement therapy education materials, a mindfulness-based app, Craving to Quit, and personalized coaching.
The workplace-based program offered to the workers at Davenport and five other residential college dining halls was unique, however. “It was all done on the (work) site. We removed all the barriers to participation and treatment,” said Stephanie O’Malley, PhD, Professor of Psychiatry at Yale School of Medicine and senior author of a paper published in the American Journal of Health Promotion that documents the program’s success. “We wanted to give it our all. We wanted to bring everything we knew about evidence-based treatments to the site but do it better.”
Researchers got support from union leaders and dining hall managers before holding initial meetings with the workers in the six dining halls. To be eligible, workers had to be 18 years old, a current smoker of cigarettes or cigars, interested in being treated to quit, and employed for at least 20 hours a week.
Twenty-five people signed up to participate. They provided a breath carbon monoxide sample and met with a nurse who took their vital signs and health history. During the six-week program, participants were given free nicotine replacement therapy such as the nicotine patch and gum, and lozenges. They could switch between products and try different flavors of gum. They also received three 15-minute counseling sessions at their workplace before choosing a day to quit, then periodic check-ins with nurses and counselors while they tried to stay off cigarettes.
As an incentive, the workers were paid for participating, and the amount of money increased each day their breath carbon monoxide levels dropped and they did not smoke. All 25 participants received at least one payment for reducing their carbon monoxide levels, and nine of the 25 were paid after it was confirmed when tested that they had not smoked.
In a post-treatment survey, participants gave the program high ratings for being helpful, and said they liked being treated at work.
Bold, Associate Research Scientist in the Yale Department of Psychiatry and the study paper’s first author, said the program proved that workplace-based smoking cessation programs do work.
She said all of the workers had access to stop smoking programs elsewhere on campus, but few had sought help to quit or used nicotine replacement therapy.
“When we brought it to them people were very willing to use it,” she said. “The real benefit was sitting down with the nurse. She opened the patch with them right there.”
Establishing trust with the workers was also critical, Kimmel said. She and Ursini developed a bond that has turned into a lasting friendship.
“They kept checking in. They made me feel good about so many things,” Ursini said. “They put me in such a happy place and I liked that place, especially without the cigarettes. I enjoyed the idea of (being paid) at first, but they treated us so well. It was like I was getting individualized private care.”
Ursini, who has two grown children and five grandchildren, had tried to quit smoking off and on for years, but never got serious about throwing away her Salem Lights for good until she enrolled in the program.
The incentive to quit had been there for many years. Her grandchildren resisted visiting her at home in New Haven because they didn’t like the smell of smoke in her apartment. She also could tell that her health was deteriorating.
“I was smelling like a chimney or a fireplace to people, my grandkids,” she said. “I was putting these little people who I supposedly care so much about in harm’s way.”
The change to becoming a non-tobacco user paid immediate dividends. Her aches and pains diminished, and she felt a renewed boost of energy. She lost weight, found it easier to breathe, and had more stamina, particularly at work, where she stands most of the day.
Her landlord was so happy he agreed to paint the inside of her apartment to cover up the smoke odor. And Ursini started putting the coins and dollar bills she used to spend on cigarettes into a jar so she could track how much she saved.
Kimmel was honored to introduce Ursini at Yale Hospitality’s Health and Wellness Fair, where she shared her success story and was recognized for remaining smoke-free.
“She captured the attention of everybody in that audience. She was so inspiring. You could not ask for a better role model,” Kimmel said.
The success of the workplace program and the positive reviews by participants caught the attention of others at the university, where administrators were finalizing details of a policy that would make the campus tobacco-free.
Yale had been smoke-free for years and removing all tobacco products from university properties was the logical next step, said John Mayes, Associate Vice President for Administration and Chief Procurement Officer at Yale.
Much like the researchers did at the dining halls, Mayes and his group reached out to stakeholders across campus to gauge opinion on the tobacco-free initiative. He said they heard concerns about enforcement, especially at conference facilities and on public sidewalks where Yale has no jurisdiction.
“We reached out and listened really, really carefully. I expected there to be a lot more blowback,” Mayes said. “But I really feel good about the outcome. I wasn’t sure how this would go. But bringing the campus another step forward felt good.”
And that will go a long way toward making Yale a more healthy place to live and work, said Paul Genecin, MD, Director of Yale Health, who supported the dining hall program and hopes it can be expanded to other locations on campus.
“If you can get a few people to stop smoking then it’s worth it,” he said. “We thought that providing that intervention to see if incentivizing people to stop smoking would be helpful. And it was.”
Perhaps the best outcome, said Kimmel, was that Ursini convinced three or four friends and colleagues to throw away their cigarettes because they wanted to quit like she did.
“For me a lot of it was being able to pass it on to these guys,” Ursinsi said of the people she helped quit. “They made me stick to my guns. They are devoted to themselves and their health. We just encourage each other.”