Tobacco Cessation Change Package

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What Is the Tobacco Cessation Change Package?
How Should We Use the Tobacco Cessation Change Package?
Spread the Word
Learn More

Tobacco dependence is a chronic, relapsing condition that often requires repeated intervention and long-term support.¹

Future smoking-related illnesses, deaths, and costs can be prevented by helping individuals who use tobacco to quit.¹ Evidence-based treatments, including counseling and Food and Drug Administration (FDA)-approved medications, are available^1–5 but are underutilized.^6–11

Clinicians play a critical role in delivering cessation support; at least 70% of persons who smoke see a physician each year.¹ Patients expect physicians to address tobacco use, and consistent interventions from clinicians improve patient outcomes.¹ Even brief advice to quit from a clinician increases quit rates, and more intensive clinical interventions have progressively greater impact.¹

Download the PDF Guide [PDF – 806 KB]

What Is the Tobacco Cessation Change Package?

The Tobacco Cessation Change Package (TCCP) is a quality improvement tool created by the Centers for Disease Control and Prevention (CDC) that:

Is intended for health care professionals in outpatient, inpatient, and behavioral health settings and public health professionals who partner with these groups.

Presents a list of process improvements that clinicians can implement as they seek to deliver optimal treatment to patients who use tobacco.
Gives clinical teams a practical resource to increase the reach and effectiveness of tobacco cessation interventions and to incorporate these interventions into the clinical workflow.

How Should We Use the Tobacco Cessation Change Package?

Start by bringing together a multidisciplinary team of stakeholders (e.g., physicians, pharmacists, nurses, medical assistants, social workers, care managers, quality improvement coordinators, health informaticians, and administrators).

The team can look at the elements in Figure 1 and conduct an assessment to determine the aspects of tobacco dependence treatment that are most in need of improvement in your health system. You may also benefit from talking directly with others who have undertaken similar efforts to learn from their experience.

Once your team has identified and prioritized the needs, interventions can be selected from the TCCP to create a supportive treatment environment to address those needs.

You can then choose strategies from the TCCP that have been shown to result in improvement. Each strategy you choose should first be tested on a small scale (i.e., conduct a “small test of change”) to assess feasibility and allow the team to evaluate and adjust before instituting the change on a broader, more permanent scale.

Health care practices should not attempt to implement all the interventions described in the TCCP at once, nor is it likely that all of these interventions will be applicable to every clinical setting.

TCCP Format

The TCCP is composed of change concepts, change ideas, and tools and resources:

Change concepts are general notions that are useful for developing more specific strategies for changing a process.
Change ideas are actionable, specific ideas or strategies that can be rapidly tested on a small scale to determine whether they result in improvements in the local environment.
Each change idea is linked to evidence- or practice-based tools and resources that can be adopted or adapted to implement each change idea.

Figure 1. Tobacco Cessation Change Package Focus Areas

Key foundations; Equipping care teams; Screening; Treatment; and Referral and follow-up.

Note: The TCCP is not a comprehensive clinical guide on treating tobacco dependence; rather, it is designed to complement other Million Hearts^® tools:

Spread the Word

Use the following sample social media messages and graphic to promote the TCCP through your personal or professional channels.

Facebook/LinkedIn

Increase the reach and effectiveness of #TobaccoCessation interventions with the Million Hearts [tag] Tobacco Cessation Change Package. Download your copy today! http://bit.ly/2YJOsZ6 #MillionHeartsQI
Looking to help patients quit #tobacco, the leading preventable cause of disease and death in the United States? Download the Million Hearts [tag] Tobacco Cessation Change Package for evidence-based process improvements. http://bit.ly/2YJOsZ6 #MillionHeartsQI
Clinicians play a key role in helping patients #QuitTobacco. Use the Million Hearts [tag] Tobacco Cessation Change Package to increase delivery of optimal treatment in your practice. http://bit.ly/2YJOsZ6 #MillionHeartsQI

Twitter

Increase reach and effectiveness of #TobaccoCessation interventions with the @MillionHeartsUS Tobacco Cessation Change Package. Download today! http://bit.ly/2YJOsZ6 #MillionHeartsQI
Clinicians play a key role in helping patients #QuitTobacco. Use the @MillionHeartsUS Tobacco Cessation Change Package to increase delivery of optimal treatment in your practice. http://bit.ly/2YJOsZ6 #MillionHeartsQI
Download the @MillionHeartsUS Tobacco Cessation Change Package to integrate treatment of #tobacco use and dependence into routine clinical care. http://bit.ly/2YJOsZ6 #MillionHeartsQI

Shareable Graphic

Where Can I Learn More?

Million Hearts Tobacco Cessation Change Package Tutorial Video
This 5-minute tutorial video will help familiarize you with the Million Hearts Tobacco Cessation Change Package and how to use it.. The video illustrates quality improvement steps health systems can take to make cessation treatment a part of routine care, and highlights the suite of free Million Hearts resources available to help clinicians treat patients with tobacco use and dependence.

Learn More

Fiore MC, Jaén CR, Baker TB, Bailey WC, Bennett G, Benowitz NL, et al. Treating tobacco use and dependence: 2008 update. Rockville, MD: U.S. Department of Health and Human Services, U.S. Public Health Service; 2008.
Stead LF, Koilpillai P, Fanshawe TR, Lancaster T. Combined pharmacotherapy and behavioural interventions for smoking cessation. Cochrane Database Syst Rev. 2016;3:CD008286.
Stead LF, Perera R, Bullen C, Mant D, Hartmann-Boyce J, Cahill K, Lancaster T. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev. 2012;11:CD000146.
Stead LF, Koilpillai P, Lancaster T. Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation. Cochrane Database Syst Rev. 2015(10):CD009670.
Matkin W, Ordóñez-Mena JM, Hartmann-Boyce J. Telephone counselling for smoking cessation. Cochrane Database Syst Rev. 2019(5):CD002850.
Quinn VP, Hollis JF, Smith KS, Rigotti N, Solberg LI, Hu W, Stevens VJ. Effectiveness of the 5-As tobacco cessation treatments in nine HMOs. J Gen Intern Med. 2009;24(2):149–54.
Schauer GL, Malarcher AM, Zhang L, Engstrom MC, Zhu SH. Prevalence and correlates of quitline awareness and utilization in the United States: an update from the 2009–2010 National Adult Tobacco Survey. Nicotine Tob Res. 2014;16(5):544–53.
Babb S, Malarcher A, Schauer G, Asman K, Jamal A. Quitting smoking among adults — United States, 2000–2015. MMWR Morb Mortal Wkly Rep. 2017;65(52):1457–64.
Marynak K, VanFrank B, Tetlow S, Mahoney M, Phillips E, Jamal A, et al. Tobacco cessation interventions and smoke-free policies in mental health and substance abuse treatment facilities — United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67(18):519–23.
King BA, Dube SR, Babb SD, McAfee TA. Patient-reported recall of smoking cessation interventions from a health professional. Prev Med. 2013;57(5):715–7.
Bernstein SL, Yu S, Post LA, Dziura J, Rigotti NA. Undertreatment of tobacco use relative to other chronic conditions. Am J Public Health. 2013;103(8):e59–65.

Authors

This document was conceptualized and authored by Brenna VanFrank, MD, MSPH*; Kaitlin Graff, MSW, MPH*; Gillian Schauer, PhD, MPH (McKing Consulting)*^†; Rob Adsit, MEd^‡; Lauren Owens, MPH (IHRC, Inc.)*; Stephen Babb, MPH*; Danielle McCarthy, PhD^‡; Anna Schecter, MPH*; and Hilary K. Wall, MPH*.

*Centers for Disease Control and Prevention

^†University of Washington, School of Public Health, Department of Health Services

^‡University of Wisconsin, Center for Tobacco Research and Intervention

Reviewers

The following individuals provided review and feedback on this document: Steven L. Bernstein, MD (Yale Schools of Medicine and Public Health); Carol Essenmacher, DNP, NCTTP (Battle Creek VA Medical Center); Tim McAfee, MD, MPH (University of Washington School of Public Health, Department of Health Services; SEED Consulting Group); Kait Perry, MPH (American Academy of Family Physicians); Sarah Price, MSN-Ed, RN (National Association of Community Health Centers); Nancy Rigotti, MD (Massachusetts General Hospital and Harvard Medical School, Tobacco Research and Treatment Center); and Catherine Saucedo (University of California, San Francisco, Smoking Cessation Leadership Center).

Graphic Design and Editorial Assistance

Graphic and HTML design support was provided by Shelby Barnes, MPH, CHES*; Booker Daniels, MPH*; Susan Davis (Northrop Grumman Corporation)*; and Jessica Spraggins, MPH*.

*Centers for Disease Control and Prevention

Website Hosting Assistance

Website hosting support of tools and resources was provided by the National Association of Chronic Disease Directors.

Contributing Organizations

We would like to extend special thanks to the following organizations for their willingness to share tools and resources to improve smoking cessation, as further denoted within the Tobacco Cessation Change Package:

American Academy of Family Physicians (AAFP)
American College of Cardiology (ACC)
American Lung Association
Arizona Smokers’ Helpline (ASHLine)
California Quits
California Smokers’ Helpline
Cayuga Medical Center
Center of Excellence for Health Systems Improvement for a Tobacco-Free New York
Essentia Health
Group Health Cooperative of South Central Wisconsin
HealthyHearts NYC
Heart Health Now!
Hospitals Helping Patients Quit
Institute for Clinical Systems Improvement (ICSI)
Institute for Healthcare Improvement (IHI)
Kansas Health Foundation
Legacy (now Truth Initiative®)
MultiCare Health System
National Alliance on Mental Illness Kansas (NAMI KS)
National Behavioral Health Network for Tobacco & Cancer Control
National Cancer Institute (NCI)
National Quality Forum (NQF)
Navy and Marine Corps Public Health Center
New York City Department of Health and Mental Hygiene (NYC DOHMH)
New York City Health + Hospitals (NYC Health + Hospitals)
New York State Department of Health
New York State Smokers’ Quitline
North American Quitline Consortium (NAQC)
Northern Lakes Community Mental Health Authority
Oklahoma Health Care Authority
Oklahoma State Department of Health, Center for Chronic Disease Prevention & Health Promotion
Oklahoma Tobacco Settlement Endowment Trust (OK TSET)
Oregon Health Authority
Partnership for Prevention
Plymouth Family Physicians
Substance Abuse and Mental Health Services Administration (SAMHSA)
Telligen
University of California Quits (UC Quits)
University of California, San Francisco Schools of Pharmacy and Medicine (UCSF Schools of Pharmacy and Medicine)
University of California, San Francisco Smoking Cessation Leadership Center (UCSF SCLC)
University of Colorado, Anschutz Medical Campus (CU Anschutz Medical Campus)
University of Maryland School of Medicine (UM Medicine)
University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI)
University of Wisconsin Health (UW Health)
University of Wisconsin–Madison, School of Medicine and Public Health (UW-Madison SMPH)
S. Department of Veterans Affairs (VA)
Wisconsin Hospital Association (WHA)
Wisconsin Nicotine Treatment Integration Project (WiNTiP)

Brenna VanFrank, MD, MSPH
Office on Smoking and Health
bvanfrank@cdc.gov

Centers for Disease Control and Prevention. Tobacco Cessation Change Package. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2019.