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The financial and human toll from tobacco* use – directly or from exposure to secondhand smoke – continues to be the most costly, preventable cause of death in North Dakota. The increased availability of Electronic Nicotine Delivery Systems (ENDS) and vaping of nicotine and other substances has only escalated related health concerns.

Tobacco use is a chronic-relapsing condition, and we should be allocating time and education to providers and patients on evidence-based treatment resources to reduce use. Seventy percent of tobacco users want to quit but aren’t sure how to try. Patients expect their tobacco use to be addressed by health care staff, and by receiving a combination of behavioral counseling and cessation mediations, tobacco users can more than double the rate of quit success.

Fortunately, we have untapped and under-utilized resources and programs to assist. We met with Kara Backer, MBA, RRT, NCTTP, the Nicotine Dependence Treatment Coordinator with the North Dakota Department of Health (NDDoH). Backer has served in this role for nearly 8 years. She assists health systems in expanding their tobacco and nicotine dependence treatment services.

Increasing the availability of high-quality, evidence-based treatment for tobacco use and dependence will make it more likely for tobacco users to use evidence-based treatments, and those quit attempts translate into long-term abstinence. Backer shared, “We seek individuals and organizations interested in offering tobacco treatment interventions. We train providers and other health care professionals wanting to improve the overall health of our communities through tobacco treatment counseling and education. There is much work to be done, and it can start with brief interventions.”

Only 1/3 of tobacco users will utilize evidence-based treatment, which includes counseling and medication.

The NDDoH has training opportunities for individuals interested in becoming a tobacco treatment specialist (TTS) and funding opportunities to support the work in health systems. Backer emphasized the need for those interested to ensure the support of leadership before completing the training. “We have had many individuals complete the TTS training, and within a short amount of time, their role would shift, and they would no longer be responsible for tobacco treatment interventions. Leadership support is critical for success and sustainability.”

Backer explained how the program works, “We have secured staff from the Mayo Clinic to provide TTS training, and these trainings occur throughout the state a couple of times a year, paid for through our grant funding. This TTS training enhances confidence in addressing tobacco use with patients. A cessation grant component includes guidance for Electronic Health Record (EHR) documentation and how to utilize tobacco data. The EHR drives and supports a streamlined and sustainable tobacco treatment workflow in health systems. Our program currently supports 20 grantees; last fiscal year, 13,500 individuals received a visit with a TTS. We have TTS in various regions throughout the state but have areas with great need and want to expand tobacco treatment services. We often rely on word of mouth, which limits our reach.” Quitting tobacco has a positive impact on communities’ residents’ physical and fiscal health.

In addition, over the past 2+ years, attention shifted to COVID-19 and pandemic-related needs, impacting the program and tobacco cessation efforts. Workforce fatigue, staff turnover and competing priorities are also barriers. NDDoH Tobacco Prevention and Control Program-funded grantees and partners have been key partners in promoting tobacco treatment services and making referrals to the North Dakota quit-line, NDQuits. Backer added, “Currently, our grantees refer over 95% of the quit-line referrals. Unfortunately, the number of tobacco users who access the quit-line is less than 2 percent. To reach more tobacco users, we engage more health care professionals to become a TTS and offer tobacco treatment interventions. The additional local resources improve access to services and increase quit attempts.”

Backer concluded, “I am most proud of the 60,000 TTS visits we have offered through our program since 2017. These tobacco treatment interventions would not be possible without the program funding, resources and our trained team of cessation experts.”

If you are interested in learning more about the cessation grant or want to become a TTS, please contact Kara Backer at The next TTS training opportunity is in October.

* Commercial tobacco – such as cigarettes, spit or smokeless tobacco, vapes, and synthetic nicotine – differs from traditional tobacco used by Indigenous communities for ceremonial and medicinal purposes. Commercial tobacco manufacturing includes adding harmful chemicals and manipulating nicotine levels to make these products more addictive.