This document describes the Helpers Program, a social and community network approach to tobacco cessation. The Helpers Program trains community members to have "helping conversations" that encourage and support tobacco users who want to quit. It is based on research showing the influence of social networks on health behaviors and that quit attempts are often unplanned. The Helpers model provides web-based or in-person training to help community members feel confident having supportive conversations about quitting resources. Several research projects have tested the Helpers approach in various communities and found it increased knowledge and helping behaviors. The goal is to engage social networks and foster communities that support tobacco cessation.

1. Consumer-Centric Health
Models for Change ‘11

2. Communities as Change Agents
Helpers Program: A Social & Community
Network Approach to Tobacco Cessation
Myra Muramoto, MD, MPH
The University of Arizona College of Medicine,
Department of Family & Community Medicine

3. Acknowledgements
Sponsors
National Cancer Institute
The Robert Wood Johnson Foundation
Arizona Department of Health Services
The University of Arizona Health Network
US Department of Defense

4. Acknowledgements
Partners
Pima Community College  Partnership for Tobacco-Free
Maine
Maricopa Community College
 Mississippi State University
Mesa Community College
 Northern Arizona University
Free & Clear (now Alere)
 University of Alabama
ICA Mississippi Head Start
 University of Minnesota
Arizona WIC Clinics
 Mohave County health Dept
Outer Limits
 Tanner Corporation
Child Time
 Cortiva institute
Arizona Smoker’s Helpline
 New Jersey Tobacco Control
American Specialty Health
Program
Maricopa county Health Dept.
 Coconino County Health Dept.
 The University of Arizona Health
Network

5. Why?
How do we reach people….
… beyond the healthcare system?
… beyond the worksite?
… across barriers to access?
Reach people where they are.

6. Social networks & smoking cessation
 Chance of smoking
decreased:
 67% if their spouse quit
 25% if adult sibling quit
 36% if their friend quit
 34% if coworker quit
 “cascades of quitting”
 3 degrees of separation
(Christakis, 2007)

7. Networks of networks
Influence
health and
disease
at multiple
levels…
Barabasi, 2007

8. Another Network Level -
Organizations and Communities

9. Quitting is not always planned
 Patients’ report of quit attempts (Larabie, 2005)
 51.6% unplanned, 64% unaided
 Many reasons for unplanned successful quits
 National household survey (West, et al., 2006)
 48.6% of most recent quit attempts were unplanned and
acted on immediately
 Unplanned attempts more likely to be successful
 Decisions to change often impulsive (West, 2006)
 Accumulation of nudges
 3 T’s

10. Brief Tobacco Interventions
 Continuum of cessation services
 Interventions by multiple health professionals increase
quit attempts and quits (An, et al., 2008)
 Population effect – “increase in quit attempts matters
more than the same level of increase in the use of help.”
(Zhu, 2007)
 Any attempt is better than no attempt

11. To Increase Quit Attempts
 Change social norms…
 Quitting is normal
 Repeated attempts are normal, so keep trying
 Help tobacco users feel more hopeful
 Reduce perceived barriers to cessation aids

12. Helpers…
Who are they?
What are their roles?

13. “Health Influencers”
Family & friends
Co-workers
Educators
Service providers
Strangers
Have motive…
Have opportunity…
Are engaged
Campbell, et al., 2007

14. Decisions about medical
treatments...
...frequently
take place within
household and
friendship
networks.
Janzen 1987; Nichter 1996, 2006

15. “Trusted members of the
community…”
....trusted by
relatives, friends, and
co-workers, the very
people for whom the
interventions were
designed.”
(Thomas, 2001)

16. Seeking help on behalf of others….
….7% of all callers to
California quit line, more
on non-English lines
(Zhu, 2006)

17. Quitting tobacco is a process…
“A journey of a thousand
miles begins with a single
step.”
Lao Tzu

18. … a journey…
Helpers encourage…
… The first step
… The last step
… A step along the way
… Not giving up on the
journey.

19. What is the Helpers Program?
What is underlying research?

20. The Helpers Program…
 Training, support,
resources for
“helping
conversations”
 Foster communities
of practice
 5 main
components

21. The Helping Conversation
Awareness
Understanding
Helping
Relating

22. Helpers Training Model
 Web-based or In-person
 Supportive non-
confrontational approach
 Information about
resources
 Referral skills

23. Helpers research and projects

24. Project Reach

25. What did we learn?
 Who came forward
 Increased
knowledge, confidence, an
d helping behavior
 Minimal intervention
increased helping behavior
 Referred to
services, discussed
medications
 Contextual influences on
helping
Muramoto, et al, 2007; Castaneda, et al, 2008, Yuan, et al, 2010

26. Helpers Free & Clear study
 Worksite
dissemination pilot
 Helpers Web
components only
 Feasibility
 Utilization
Muramoto, et al, 2010

27. Helpers New Jersey
 In-person & web training
 Community Resource
Center
 Helpers Quit Kits
 Community creativity &
experimentation

28. Helpers Quit Kits
 IDEO
 Facilitate helping
conversations
 Integrate “Helpers Journey”
experience
 Outreach & Graduation
Muramoto, et al, 2008

29. Current work

30. Communities as change agents…
 Need community-based approaches
 Engage, activate social networks
 Foster communities of practice
 Helpers arose out of a decade of community-
based research
 Still evolving based on community needs

31. Thank you!
myram@email.arizona.edu
http://helpersarizona.org