Rose Aulino, a registered nurse who works in the Mental Health Center on the 3rd floor of the Columbia County Human Services building, has helped dozens of clients beat their nicotine addiction. Every November during the American Cancer Society’s Great American Smokeout, Aulino, a.k.a. “Nicotine Ninja,” appears throughout the building, as if swiftly defeating a thousand discarded cigarettes. She wears a purple cape and headscarf, waving a larger-than-life cigarette replica, which she refers to as her “quit stick.”
Although Nicotine Ninja appears just once a year, Aulino’s daily work is central to tobacco control and prevention work in New York State. As a health care provider who serves the New York State Smokers’ Quitline, Aulino partners closely with local experts at Tobacco-Free Action of Columbia and Greene and with a wider network of NYS Department of Health grantees from Advancing Tobacco-Free Communities and Health Systems for a Tobacco-Free New York. Grantees from both programs are part of the statewide effort to reduce tobacco-related deaths and disparities.
During our interview, Aulino shared a few of her clients’ nicotine journeys that have made an impact on her. To protect clients’ identities and medical privacy, all stories were kept anonymous during the interview. Quotations have been minimally edited for conciseness and readability.
QUIT STORY 3
In addition to the tobacco-use disparities that still exist among New Yorkers who experience frequent mental distress and lower incomes, the tobacco industry distorts the proven public health message of evidence-based cessation, suggesting that vaping and other non-FDA-approved nicotine-based products are safe, creating confusion.
Before meeting with Aulino, some of her clients moved from smoking cigarettes to vaping, thinking it would help them quit. Aulino shares, “Vaping, by the way, has not been shown in any study to help you quit smoking.”
I helped a teenager quit vaping, and … like most teenagers, he was ambivalent about quitting … because it’s cool to vape when you’re a teenager … and your friends are doing it, so it’s like super cool. I think the reason he wanted to quit … [was] his father really wanted him to stop vaping, and they talked about it all the time, but then it became a bone of contention between them. So … we developed a rapport and I just hit him with the facts … like the interference in people’s brain function that happens with vaping.
“In your experience, what approaches have been most successful, whether it’s the use of individual or group therapy, Nicotine Replacement Therapy (NRT), or using the NYS Quitline?”
“My approach with people is I meet with them, and I get an idea of what their smoking history is, because the more times that you try to quit, you’re more likely to be successful on subsequent quit attempts. So, after I get an idea of their smoking history and how strong their addiction to tobacco is, or maybe I should say nicotine … we agree upon an approach.”
“NRT is a very important part of it. If you’re using NRT, you’re 50% more likely to be successful at quitting than if you aren’t. If we talk about [nicotine] patches … the first step is the 21-milligram patch. The conventional wisdom now has changed. It used to be that you tried either the patch or the gum or the lozenge, but conventional wisdom now says that you’re more likely to be successful if you’re using the patch and then using the gum or the lozenge for breakthrough cravings.”
“The Quitline definitely comes into play. I always try to plug the Quitline because I’m one of 10 medical advisors to the New York State Smokers’ Quitline. The Quitline comes in … if they need to get free NRT. The Smokers’ Quitline will give you two weeks of free NRT. Insurance will [also] cover it if you have a doctor’s prescription for it.
In office, Aulino’s clients currently consist of patients enrolled at the mental health clinic, to whom services are free without a co-payment to clients. She notes, some insurances cover smoking cessation counseling, but others don’t; so, it’s worthwhile exploring what your options are if you’re a nicotine user interested in quitting.
“What still drives you to make tobacco such a big focus of your work?” Aulino’s response: “It’s always been people.”
“Smoking has always been part of my professional life. I started my career in critical care nursing, and in critical care nursing, you’re taking care of people who are on ventilators. And most of the time people who are on ventilators … because they’ve been smoking all their life and now they’re older and it has caught up with them…Or they have a heart attack, or they have a stroke…or they get cancer. Sometimes people can’t get off the vent once they’re on the vent…depends on how extensive their lung disease is.”
“The damage had been done. That’s sort of where I started from is like seeing firsthand the real tangible effects of long-term cigarette smoking.”
“So as a nurse, I’d rather help somebody stay healthy than take care of them when they were sick.”
“It’s a natural part of a nurse’s job to talk to people about that stuff. But it’s a particularly natural part for a psych nurse. My business is to talk to people.”
Tips for the Public
“What do you say to people who may be on the fence about quitting to get them interested?”
“Oh, well, there’s a thing that we do called motivational interviewing. And motivational interviewing is presenting people with the pros and cons. You’re saying, okay, so what are the pros of smoking? Smoking? And then what are the cons of smoking? And nine times out of 10, the cons far outweigh the pros. So sometimes people need to see that in black and white.”
“And then sometimes they’re like, ‘yeah, why am I smoking?’”
“The other part of motivational interviewing is that we assess readiness. That’s part of it … even if they do a list of pros and cons and there are so many more cons … sometimes they’re still not ready to quit. And then the next question is, ‘What would make you ready to quit?’”
“So, we usually ask people on a continuum of like one to 10, what’s your readiness to quit? And one is like, ‘no way, Jose.’ And number 10 is, ‘I’m ready today.’ So, if they say ‘five,’ I’d say, ‘what would it take to get you to a nine?’”
Aulino states, “For anybody out there who feels like they’re ready to quit or wants to talk about possibly getting ready to quit, I would encourage them to just call the Smokers’ Quitline,” The number for the NYS Quitline is 1-866-697-8487.”
As Aulino indicates, quitting tobacco is hard and takes repeated effort, but working together on a statewide, local, and individual level will give our community members the best chance of success and help build healthier Columbia and Greene counties.