Travis County Commissioners Court
Tuesday, July 13, 2010,
Item 13
>> number 13, consider and take appropriate action smoking sessionization program for travis county employees. A, approval partnership with dr. Garyly elkins, baylor university, for year one of a two-year pilot program/study of hypnotherapy for smoking cessation, and b, request to approve $1,250 for funding year one from the wellness budget.
>> we would like to enter into with baylor program on smoking cessation. The doctor has been looking into the program and has information to share with the court. We would ask that this be an informational session and that this item be rolled to next week so we can work with the auditor's office on disbursement arrangements.
>> okay.
>> good morning, judge and commissioners. Harry dare, medical director for the health and wellness clinic. We would like to perform a pilot program with baylor university mind and body research institute with dr. Gary elkins to form a pilot program onhypnotherapy. We have doctors who prescribe medication at no cost to the employee. And in 2009 we had 79 employees who were prescribed medications and out of those 26 quit smoking for six months or more. Unfortunately, 20 of those employees also stopped the medication because of the side effects. The main medications that we do use is zyban and chantix, and the f.d.a. Has warnings for these because they have severe psychiatric side effects. They can cause hostility or suicidal eye dation, depressed move and as i said 20 of our employees had side effects and had to stop the medication. We also have other programs in place, counseling programs that we do on an ongoing basis, and we also give information to individuals who want to stop smoking through the state quick lines, and they offer counseling opportunities over time. We have found that success for smoking cessation occurs if you have a multi-modal approach. We have the counseling sessions that we're performing at the moment. That would be another alternative, or the quit line and nicotine gum. This program is another opportunity for individuals to try something that may work for them. Dr. Elkins has been studying hypnosis and he is a psychologist that is nationally known, and he has performed a study on hypnosis for smoking cessation, and his quit rates are 26 weeks for 40%, which is quite high. And if you take the cdc prevalence of smoking at approximately -- in 2006, the cdc estimated 21% of adults are smokers. Using that figure, approximately 945 employees out of the 4,500 would be smokers and
>> [indiscernible]. And recently there was also another study performed which was presented at american association of chest physicians, and the study was performed at massachusetts general hospital, and they had -- they had 67 participants in the program. These were patients who were hospitalized for cardiopulmonary disease. And out of the 67, there were put into four groups, and the ones who -- the hypnosis group, 50% had stopped. The group which had hypnosis and nicotine replacement, 50% stopped, and out of the control group 25%. And only nicotine replacement approximately 17%. So we would like to do this pilot program with dr. Elkins. It is a pilot program, and we will at the results and see how it benefits county employees. And the health and wellness team are the ones who are going to do the program, so once dr. Elkins has sort of consulted and taught us, then it will be an ongoing program which may carry on with the resources we have in the county. I would just like to give one of our employees, and she actually underwent some sessions, hypnosis sessions, and i would like melanie collins to share her experience and just tell us how she felt.
>> okay. Good morning, your honor and commissioners. I'm hoping i get through this without melting like a stick of butter in a microwave. I would hope this -- my name is melanie collins and i work for travis county counseling and education services. I'm a drug and alcohol counselor. My hope this morning would be that i could be persuasive in regards to the hypnotherapy program. I smoked for 37 years. Probably 30 of those a pack a day or more n the past 10 years, i have tried several times to quit smoking, serious attempts to quit smoking. The zyban and the chantix didn't work for me. I tried the patches. I never got more than two weeks off cigarettes. With this class opened up, i saw it on the travis county internet. I felt like i'm going to give it a chance. I'm going to try one more time. And when i went to the class, i was the only person there and i thought, oh, boy, they are going to cancel the class and i can smoke for another six months until we fill it up. But the doctor said if we can just get one person to stop smoking, it's worth it, and if you want to be that person we'll continue on with the class. And i said okay, no pressure here. But i did attend the class and along with many of the other tools that i already had tried to use, dr. Deer directed or guided me through some hypno therapy. We did it for at least 15 minutes each session and it allowed me to relieve myself of a great deal of stress, which is one of the big reasons that i smoked. It also helped me to see myself in a positive light. There's been a lot of negativelyism about people smoking. You can't smoke in restaurants, you can't smoke anywhere anymore. And it gives you a little bit of shameful feelings when you are kind of like ostracized from society for smoking, so it gave me a way to see myself in a positive way. It gave me the opportunity to regress back to that first cigarette when i was 15 and to tell myself this is what's going to happen if you smoke that cigarette. And it wouldn't be the advice of an adult telling me don't smoke, it's bad for you, it would be the advice of me myself having lived that experience, being able to tell that 15-year-old don't do it. And then to see my life without cigarettes and be able to see myself much healthier, without smoking. I don't refer to myself as a ex-smoker, i refer to myself as a nonsmoker. In nine days i will have nine months smoke free and i think the hypno therapy was the biggest asset as far as me being able to quit smoking. I still use it. I especially use it at 4:30 in the afternoon when i'm sitting on i-35 in bumper to bumper traffic and i want to scream. It helps me calm down. I had a family emergency not too long ago that would have sent me scream fog a pack of cigarettes. I used the hypno therapy technique and managed to get through it. I'm in better control of my feelings and emotions and if i can just lose the 16 pounds that i gained from not smoking, i'll be a happy girl, which i did enter into the walk across texas and managed to lose six pounds so i'm feeling a lot better about myself now. Just ending up, i would like to say i really appreciate travis county making this program available to me and helping me to achieve the goal of being a nonsmoker. I would like to thank my co-workers for allowing me to attend and dr. Deer for being so supportive throughout.
>> thank you for sharing. Let me ask a couple of questions, i guess, and if you are -- if you've had a chance to say the necessary things to get this going with this particular program. Can you possibly tell me how outreach would be done in a pilot project, how outreach would be done for persons that have serious addiction of smoking, how would that actually be achieved to make sure that the opportunity is given to the masses of those that are having trouble kicking the habit of smoking, how would that be done? What do you have envisioned to make sure that it is as inclusive as possible to circle the wagon, per se, as far as bringing those folks through this process. How would the outreach be done? Would you answer that for me, please?
>> we have already sent survey out to all the employees.
>> all right.
>> and we had 622 respondents.
>> okay.
>> and out of those majority were nonsmokers. Only 53 were smokers and 28 were in the long-term program. We did advertise that through the wellness website and through surveys and also for the other programs that we -- through the clinics. Okay.
>> a lot of individuals come to the clinics and they are looking to medication and quit line counseling.
>> okay.
>>
>> [inaudible].
>> i'm sorry. Could you repeat.
>> clinic administrator to e-mail announcements and we would post the information on the website, as dr. Deer says. And i don't expect that we're going to be treating all 936 smokers, but i think --
>> the pilot probably 50.
>> we would be looking at the first 50 interested individuals to come through.
>> so is there a capacity limitation as let's say look beyond that, let's say you hit the bullseye and more folks came forward in this pilot project than you anticipated. What would be the magic number to make sure that they are served? Is there just a control number that you are looking for to be served?
>> yeah, we're looking at approximately 50 individuals, and with smoking cessation, a lot of smokers don't want to quit because they have a strong nicotine addiction. And just like in some of the classes that we held, turnout is not that good. We don't envision more than even in our -- we sent the survey out to all the employees and out of those 28 were ready to quit.
>> and correct me if i am wrong, this is an eight-week program, so each eight-week session would have 50 -- capacity of 50 participants.
>> 50 participants. Okay. Now, as far as the schedule is concerned, i mean a lot of folks here, you know, they work, and is there anything outside of working hours?
>> yes. We can make -- we will make arrangements for, you know, after hours or maybe before work starts or during lunchtime.
>> okay. Thank you. I have a couple more, but i know my colleagues have some questions they probably would like to ask also.
>> so in terms of sort of hypothesizing what we're hoping to see, are we hoping to see a certain level of success?
>> yes. We're hoping to have the same success that dr. Elkins had or the massachusetts general hospital study had, which is 40 to 50% quit rate. And according to the c.d.c., each individual smoker in terms of medical costs and productivity and health costs at least $3,300 a year. And another consulting group called the mercer puts that cost at 5,500, not to mention medical benefits an individual will achieve.
>> and the cost associated with the pilot is?
>> well, the mainly the cost associated with the pilot is $12,050, but majority of that is for dr. Elkins consulting. I think i -- in the attachments there is attachment with the breakdown of the costs, and there is a small cost related to providing recordings for these individuals so that they can -- melanie has been able to do it herself, but sometimes it helps if you have a c.d. And the program would be individualized, so that's one of the other advantages.
>> okay.
>> so we think we'll be ready for action next week?
>> yes, we'll work with the auditor's office to structure the reimbursement agreement and we can roll this in one week, we'll be ready.
>> judge, i have one more final question.
>> okay.
>> before we move on. And my only other final question is that do -- have there been any demonstration of -- and it's all about willingness to quit. I mean, you know, if you don't have the will of the person, you don't have the person. And the success rate of this particular hypnosis type situation, i think -- my concern is how detailed will the procedure of what we are doing, of what you are requesting to be done in this pilot time frame schedule, the details of that, how would that be related to the employee to make sure that -- because hypnosis and stuff like that, how would that be made available for the person to really understand the procedure? I don't know if there is anyone that may hesitate, say, well, hypnosis, i don't know about that. I used to be a smoker when i came here to travis county, i used to sit on the balcony and used to smoke, right on the balcony in the back. And i smoked for a while. But one day i just decided to quit and i did and now it's been years, several years, and i don't know what i attribute it to, but i said the heck with smoking. But everybody is not the same and that's what i'm trying to get to that middle ground where everyone is not the same. Some folks cold turkey. I went cold turkey, just quit. And it's been, like i said, maybe seven, eight years. But the bottom line i'm trying to get to, i'm trying to get the middle ground on how we can get the most mileage out of what we're doing with this program. I don't want to make sure that no one is left out because they feel embarrassed or they may feel this or that, not knowing exactly the procedure, they may be scared off. I want to be sure all those rocks are uncovered and detailed enough where people won't be -- won't shy away and just, you know, so -- you know, that secondhand smoke bothers other people also.
>> dr. Elkins has integrated all the psychological behavioral aspects or strategies into a hypnosis, so it's going to be relevant for all individuals who are smoking, there are various theories, one is the stages of change, that people are at different levels of readiness, and there are behavioral strategies to move an individual from one stage to another. There are some individuals who are pre-contemplators, which means that they are not even thinking about smoking cessation. And there are strategies to move them to the next stage, which is contemplation where they are actually thinking about stopping smoking. And the next phase is preparation and action, and you obviously had got through all the stages of change and were ready to quit and you just made that decision. But we'll be integrating the behavioral strategies with the hypnosis and making it more effective. And we'll make that available to all the individuals and explain -- dr. Elkins, that's why he will be consulting, and he's drawing up all the protocols and all the procedures that we'll be going through.
>> okay. Thank you.
>> thank you so much for presenting this.
>> we'll see you next week.
>> thank you all. Thank you for your testimony.
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Last Modified:
Tuesday, July 13, 2010 2:35 PM
