Caitlin Whyte (Host): Welcome to In Their Words, a podcast from the UPMC in Central PA and the UPMC Pinnacle Foundation, where we share the stories of people whose lives have changed through exceptional care, innovative programs, and the generosity of our community.

In our last episode, you heard Bill's remarkable journey of quitting smoking after decades of unsuccessful attempts. Today, we're joined by the woman who helped make that transformation possible. Pamela Miller is a certified tobacco treatment specialist and health educator with UPMC Central PA.

In this conversation, she shares how UPMC's Tobacco Cessation programs combine education, personalized support, and practical tools to help individuals and employees take the first step toward becoming tobacco-free. She also reflects on what it meant to witness Bill's success and why stories like his continue to inspire the work she does every day. Here's Pamela's story in her words.

Pamela Miller: My name is Pam Miller, and I am one of the tobacco treatment specialists here in UPMC Central PA. I've been in this role going on 14 years, and my professional background is a registered respiratory therapist, and I've been with the system going on 21 years.

So, my work as a registered respiratory therapist for many, many years prior to this role, working with wonderful people and patients in the hospital led me to this work. Many of my patients were struggling, were current smokers and current tobacco users and struggling with quitting. And, as a respiratory therapist, I knew that it wasn't good. It was that's what we learn in school. But I was not very confident about it, because it can be a very sensitive subject with people. We're all human, and we do different things. And, you know, we do a lot of different things based on our life and our experiences and what we know. When patients came into the hospital, as a respiratory therapist, I just cared for their lungs. And when you can't breathe, nothing else matters, right? And that was my main focus.

But I was approached by one of our tobacco cessation educators at the time. She asked me, and the minute she asked me if I wanted to help people quit smoking, I just knew. I'm like, "Yes, I would love that." So in a way, it found me in a way. My dad also smoked till I was about 13, but having that connection with patients as a respiratory therapist, being very passionate about patient care and treating people with respect and just caring led me to this role.

So, the tobacco cessation program, and I'll go back a little bit to talk about our training at the Mayo Clinic in Rochester, Minnesota, the Nicotine Dependence Center, there specifically that all three of us are trained in tobacco dependence and have our certified tobacco treatment specialist credential. They are amazing professionals there. There are trainings available. I mean, there's so many resources today for healthcare providers to help patients. It's just really amazing. But our program goes along with evidence-based research of what helps people be able to make this change in their life.

And really goes back to the three things that are recommended, we think of, again, the research and the studies that are ongoing and what helps people be able to do this. There's so many organizations and so much, again, available to help, not only healthcare providers, but people themselves.

So, three things I always go back to are effective support for people. I think that's so underrated sometimes. And by effective support, I mean more encouraging, positive to help people versus any negative. Now, it usually comes from a good place. Our family members, you know, our friends and our community want us to be healthy. But distractions and adding some different activities and allowing that person, if you're that support person, just to be there as standby and let them kind of navigate this change and tell you what they need. A lot of times, you know, no nagging, no bribing, that actually ineffective support can actually keep a person smoking. So again, number one, effective support.

Number two, having a plan. And that can involve working with your primary care doctor, working with a tobacco treatment specialist both, to what is this going to look like? Am I going to pick a quit day? Or am I ready to pick a quit day? If not, how do I build on it? So, having that open discussion, and that involves us as tobacco treatment specialists listening to that person's life. I mean, they're the expert in their own life. I always tell people, "I'm a guide. You're the driver of this." And so, yeah, we can really listen to that person's experiences with quitting, including how many attempts.

It can take someone 20 to 30 attempts to be able to make this change. And so, again, having a plan of what this is going to look like. Not that people haven't been able to do it abruptly, that people can do that too. But if that abrupt quit hasn't worked, then it's so important to kind of tailor these programs to what that specific individual needs, and that involves listening and discussing a quit plan and going through that person's day or life or just kind of say, "Okay, what is this going to look like for you?" And so, that's really important.

And number three, tobacco cessation medications. There are currently seven FDA-approved tobacco cessation medications to help people help relieve or control, nicotine withdrawal symptoms. So, it's really important. A lot of people may not know there's seven. I talk to people, and they go, "Oh, I've heard of the nicotine patch or the nicotine gum, but I didn't realize there was more medication." So, that's really important to help people. Withdrawal, we think of nicotine withdrawal, irritability, anger, moodiness, shaking. I mean, it's drug withdrawal. So, the medication is there to help people.

Now, you don't have to use medication. But I find that understanding how it helps can really help people make that informed decision whether they want to use medication or not. Pinnacle Health Foundation is amazing. We have an NRT voucher program that covers tobacco cessation medications for patients and people in the community that if their insurance doesn't cover the cost of the medications, that program is there, and also involves working with a tobacco treatment specialist as well. And then, we have the state program, 1-800-QUIT line.

There's, again, so much to help people today. But those are the three things: effective support, having a plan and that can include tobacco cessation counseling, you know, talking, to someone about the plan, and tobacco cessation medications. So, those three things can really increase the chance of people being able to make this change in their life.

One of the things about Bill that stood out for me, I mean, he reached out like three times, I knew that he was really ready for this. He did not want to smoke or use tobacco anymore. And he actually signed up for his work site class. Our Cares team did health fair at his work site, Class Taylor Communications, if I can mention their work site in New York. And then, I did a lunch and learn specifically for tobacco cessation, and then they opted to have a class.

And so, Bill reached out for his work site class. He reached out to Tobacco Cessation, myself, at UPMC in York. I'm specifically located at Memorial. And he came in a couple times, I believe for individual session, and then he joined the September 2019 class at UPMC Memorial. So, I knew that really wanted this, and he had tried for so long. That's a little bit of his story, but going back to triggers, that's something that we talk about. I love that, too. Being aware, we help increase people's understanding of why they're smoking and why they can't stop.

In Bill's case, I feel like if we gain knowledge about that, I've tried so long, I'm trying these different things, and it's not working, knowledge is power, right? The more we know, the more we can learn and develop a plan and be able to make a change. And I felt like that was a big part of really increasing the knowledge of why am I smoking? And in class, we talk about the speed of nicotine delivery to the brain, and how the tobacco industry changed the cigarette. They re-engineered and added thousands of chemicals to speed nicotine delivery and really understanding that. And what can I do when I'm experiencing cravings and strong urges to smoke to delay it for a couple minutes and just see if I can work through it.

And talking how the medications help and how they're different, how nicotine replacement medications are different than the nicotine that in tobacco products that's laden with thousands of chemicals. And the harmful burning that causes disease. So, it's a complete difference. A lot of people may not understand the difference between those two different things.

And so, really, yeah, in his case, it was increasing his understanding and helping to empower him or increase his self-belief that he could actually do this. And that support and community, which I think kind of goes hand in hand. Again, support, I think, is so underrated in this, and I think that really benefited him. He actually attended a few support groups at UPMC Memorial prior to COVID. When we went virtual with our support groups, now we have an online support group on Facebook, UPMC Nicotine Dependence Support Group on Facebook, and we also have a virtual monthly support group. So, yeah, so some people, many people need ongoing support for many, many years to be able to maintain this change, and that's okay.

So really in, again, in Bill's case, it was Increasing understanding and knowledge and using medication and support and community. And again, his reaching out and signing up for three different options, you know, I knew that he was ready. People need more tools. Again, we know what we know, and sometimes it's so wonderful to add and to help with knowledge and learning and adding more tools to increase that person's ability to be able to make this change. I feel so grateful to be able to help people and do this role that I absolutely love. And It feels great. And also, so grateful to the system and my director.

And so, there's different ways to find the program. So, you can look up UPMC Tobacco Cessation. People can reach out, call on the phone. Providers, specifically UPMC system providers, you know, that includes primary care practice physicians, pulmonology, cardiology, oncology, the Hillman Cancer Center and providers can put a direct referral with the patient's awareness and agreement for the referral. I speak of my coworker, Shannon Mason, I also have a coworker, Adam Bennett, and they're both amazing. And Shannon and I are specifically under the CARES team, which is we provide health and wellness screenings and presentations to work sites and employers, employees. And so, there's that avenue as well. So, there's several ways to find us.

It's important for us, our team, our tobacco cessation team here in UPMC Central PA, that we continue to try to change the face of what support looks like for the person that is considering making this change. Now, again, messaging, especially, you know, we think of healthcare providers, we think of the health effects of smoking on every organ system of the body. The messaging is so important. Please stop. This is happening. You need to stop smoking. And at the same time, again, we can fill in those gaps of care with more information, more support to actually help. I've been doing this since—I started when I was ten, 11, 12, 13, 14. Over 90% of the people start under the age of 21. So, that's when the brain takes the nicotine so easily. So, people, this is my normal. This is what I do. And, again, changing the face of what help and what support looks like.

So, people know they're in a safe connected space. They can share openly and be treated with dignity and respect and while they're going through this change. So, changing the face of what effective support looks like for someone making this change in their life, I think, that's so important.

Medicare, Medicaid for tobacco-related illness and diseases, chronic diseases is about, for healthcare systems, $300 billion a year. They don't know that.

Caitlin Whyte (Host): Thank you for listening to In Their Words. We hope Pamela's insights and Bill's story from our previous episode serve as a reminder that it's never too late to make a life-changing decision, and that the right support can make all the difference.

If you or someone you know is interested in learning more about tobacco cessation resources available through UPMC Central PA, we encourage you to explore the programs designed to help people quit for good. To learn more about the UPMC Pinnacle Foundation and how philanthropy helps support programs that improve the health of our communities, visit upmcpinnaclefoundation.org. If you enjoyed this episode, please subscribe, leave a review, and share it with someone who might find hope and encouragement in these stories. Until next time, thanks for listening.