Erin Dengler '14

Erin Dengler is a Neuroscience major from Rocky Mount, NC. She used her Johnson Opportunity Grant to intern at UNC Horizons, a non-profit organization in Chapel Hill, NC.

UNC Horizons is a non-profit organization associated with the Department of Obstetrics and Gynecology at the University of North Carolina at Chapel Hill. Since its founding in the early 1990s, Horizons has worked to provide healthcare and resources for substance-dependent women. Among its many services, Horizons offers clients housing, prenatal care, case management, group therapy, and transportation. However, UNC Horizons stands apart from other comprehensive treatment facilities in its efforts to care not only for the women, but for women's children as well, offering child care and child therapy services.

On my first day of work, I pulled into the parking lot of the nondescript office building. As I get out of my car and walk into Horizons, I notice a group of about ten women smoking in the corner of the parking lot. I simply nod my head and smile in their direction. Little did I know the impact that sight would have on my summer internship.
By 4 p.m. on that first day, I am sitting in a meeting with the UNC Horizons Smoking Task Force, a group comprised of seven different Horizons staff members. I am the newcomer, but I quickly learn the concerns that have led to the creation of this group. While all of the UNC campus is smoke-free, because of its client population, Horizons has a difficult time enforcing this regulation, especially in the apartments where women cannot constantly be monitored for cigarette usage. Furthermore, because the majority of the women enrolled at Horizons smoke, this activity becomes a bonding experience, and some women may begin smoking while enrolled to conform to the standards of the group.

The concerns being discussed during that first meeting introduced me to an aspect of substance abuse treatment I had never considered, and I realized immediately that I had a lot to learn. For instance, would reducing or quitting smoking threaten these women's sobriety? When they have an urge to use an illicit substance, smoking could be an alternative behavior, and taking that option away could be detrimental. As this first meeting informed me, research does not support this idea. By the time I left the conference room, I was laden with tasks, large and small, to help the Smoking Task Force.

One of my largest projects at Horizons for the Smoking Task Force this summer was to conduct a survey of the staff regarding their knowledge and attitudes on smoking cessation. The long-term goal the task force has established is to include a smoking cessation goal in each woman's treatment plan, even if that goal is to continue not to smoke. Hopefully, with this added aspect to the treatment program, Horizons will begin to see a decrease in the number of women who exit the program as active smokers. However, before such a policy change can be effectively enacted, it is important to know the feelings of those who will actually be implementing the policy on a day-to-day basis. The task force needed to know the current attitudes, knowledge, and smoking status the of Horizons staff.

I began researching the literature for information on surveying staff at a substance treatment facility regarding this topic. I adapted a previously published survey to fit the needs of the smoking task force. I also performed significant research on electronic cigarettes. Because these are becoming a large problem, questions on these forms of nicotine use were added to the staff questionnaire.  
My research on the smoking problem did not end with a literature review. I met with therapists and case managers who discussed the difficulties in fully implementing the smoke-free campus UNC promotes at Horizons. I toured the Horizons apartments, smelling the mix of air freshener and tobacco from women trying to cover their smoking. I observed multiple sessions of a group entitled Healthy Lifestyles and heard clients discussing their progress, or sometimes lack thereof, in reducing their cigarette use. And everyday, I continued to see groups of women sitting outside Horizons smoking.

The survey results revealed that the staff members are indeed ready for a new policy regarding smoking at Horizons, with over 60% of those surveyed believing the current policy is ineffective. However, staff reported that they do not feel sufficiently trained to help women quit. Furthermore, less than 15% of all staff members regularly ask a woman to stop when they see her smoking on UNC property.

Clearly Horizons needs a new policy to fix this problem which at first glance may seem insignificant. Horizons is helping women overcome their alcohol, heroin, and cocaine addictions--what's a little tobacco? However, this "harmless" tobacco is having a negative effect on their health and more importantly the health of their children. Furthermore, these women have entered treatment because they want a change. Horizons must capitalize on this teachable moment in order to help these strong women live the most healthy lives possible.