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PHOTO CAPTION:  Much like Soldiers working together to overcome an adversary, Kelda Hodges' tobacco cessation program seeks to help people beat this addiction.

September 5, 2013
By Mary El Pearce, Health.mil

FORT SILL, Okla. (Sept. 5, 2013) -- Everyone knows that tobacco is bad for you, and yet its use is common in the U.S. military.

The negative effects range from respiratory disease to pancreatic cancer, the Centers for Disease Control and Prevention reports, but for many service members, quitting tobacco can be a nearly impossible mission.

Though the issue is one that health care providers struggle to resolve, Kelda Hodges, a registered nurse and tobacco cessation program director at Reynolds Army Community Hospital, believes she is on to something.

Three years ago, Hodges came to Fort Sill to take over the cessation program -- a two-hour class that ended with a certificate and prescription for Varenicline. The drug helps ease nicotine withdrawals and is sold under the brand name Chantix.

"There was no follow-up," said Hodges. "I knew we could do better."

During the first few months, she researched data on tobacco cessation, including the 2011 Department of Defense Survey of Health-Related Behaviors. The survey revealed almost half of U.S. service members used tobacco products.

She decided to use the American Lung Association's tobacco cessation program, Freedom from Smoking, as a model. Fort Sill's tobacco cessation program expanded from one class to six weeks that also included one-on-one counseling.

"People don't like six-week programs, but I think that's the healthiest way to quit," said Hodges. "If you can't put tobacco down and never think about it again, one class is not going to help you."

Hodges acknowledged committing to six weeks is not ideal for service members who may be going on leave or in the field and may miss classes. However, by making herself available for phone calls or via email, she believes the course is still a viable option. She set up a hotline, 580-442-QUIT, which allows people to leave her messages and find out information about upcoming classes.

Most important though are the individual counseling sessions.

During appointments, Hodges talks to patients about their concerns and works on tailoring the program to their needs.

"Making it their own program and letting them have some control over it is important," she said.

The DoD survey stated 84 percent of heavy smokers smoke to help them relax or calm down; 82 percent smoke to help relieve stress. These two reasons were also the most commonly cited among light to moderate cigarette smokers (75 percent) and those who smoke infrequently (60 percent).

"Tobacco is a great way to handle stress or boredom," Hodges admitted. "Nicotine will help calm your brain and give you energy. It will make you feel more awake. It's a tempting drug for our military."

Because nicotine is highly addictive, Hodges has an arsenal of tools to aid patients in quitting tobacco. In addition to

Chantix prescriptions, she provides sugarless gum and key chains, courtesy of Quit Tobacco -- Make Everyone Proud -- but she warns her patients that quitting will not be easy.

"You're never going to replace tobacco," she said. "You have to find things that help put you back in control."

Hodges said nicotine releases dopamine in the brain, and taking away the nicotine causes people to crave cigarettes or smokeless tobacco. She tells her patients to do 30 seconds of vigorous activity to help ward off cravings.

"Instead of sitting on your hands, do 30 seconds of push-ups," she said. "It's never going to be as good as a cigarette, but 30 seconds is enough to hit that dopamine addiction."

Fort Sill's program is open to service members, retirees, DoD civilians, contractors and TRICARE beneficiaries. Hodges said most of her patients are active duty and tend to be younger. The 2011 DoD survey revealed males with a high school education or less were more likely to be heavy smokers compared to females and people with some college or more education.

"As these men become more educated and responsible, they give up tobacco," Hodges explained. "It's important for their careers, their health and their readiness."

For Hodges, this data underscores the need to educate service members early on, and she hopes to one day take the messages from Fort Sill's program into basic training.

"Tobacco is the number one preventable cause of death," Hodges said. "If service members just stayed 'quit' in basic, they wouldn't have this obstacle now."