A personal issue turned into a professional dilemma for Rora Kellis when FirstHealth of the Carolinas became North Carolina’s first tobacco-free health care system in 2004.

As an employee of FirstHealth’s security department, Kellis was a member of the team that would enforce the tobacco ban at Moore Regional Hospital.

He was also a two-plus-pack-a-day smoker.

Kellis figured the only fair thing for him to do would be to give up his own tobacco habit.

“I felt the only way I’d be able to (enforce the tobacco ban) with any kind of conscience would be to quit myself,” he said.

A smoker since his early teens, Kellis entered FirstHealth’s FirstQuit program not only expecting to fail but also at odds with the no-tobacco policy. People aren’t at a hospital because they want to be, he reasoned, but because they have to be. It hardly seemed fair to ask them not to use tobacco at a time of personal difficulty.

“We tell them they can’t do something that is a stress-reliever for them,” he said. “The only way to strengthen my argument was to go to the tobacco-cessation classes and say, ‘See it didn’t work.’”

Except that the classes did work.

Kellis gave up smoking in March 2004. He credits his success to the individualized approach that FirstQuit offers each of its participants — more than 3,200, to date.

“They didn’t tell me this is how you’re going to do it,” Kellis said. “It didn’t work that way. They asked me what I thought. They got my buy-in by asking me. Now it’s hard for me to remember what it was like to smoke.”

By the time that FirstHealth of the Carolinas “declared its independence from tobacco” on July 4, 2004, its Community Health Services department had been offering quit-tobacco classes for about three years. A 2001 grant from the American Legacy Foundation, using funds from the national tobacco industry settlement, had provided the money for quit-tobacco classes offered through local provider offices and work sites.

In 2003, as FirstHealth prepared to take its campuses tobacco-free, the quit-tobacco program officially became known as FirstQuit. Additions to the program included a support group, medication assistance and group classes. The program was also opened up to participants in the general community beyond provider referrals and work sites.

“When we were developing the program, we researched the best practice models of the time and incorporated the information into our situation,” said Chris Miller, director of FirstHealth Community Health Services.

The result was a program that focuses on each individual entering the program and his/her unique quitting experience. FirstHealth also began to provide technical assistance to other hospitals and work sites interested in going tobacco-free. As an organization headquartered in a historically recognized tobacco county in a historically recognized tobacco state, FirstHealth had valuable information to share from its tobacco-free experience.

“FirstQuit was an actual piece of that whole process,” Miller said.

Today, FirstHealth Community Health Services has six health educators with national certifications as tobacco treatment specialists. Five were trained by the Mayo Clinic, and one earned her certification from the University of Massachusetts.

Many work sites throughout the FirstHealth service area have welcomed the FirstQuit program as a benefit of FirstHealth’s FirstCarolinaCare Insurance Company. Others have no FirstHealth affiliation, but want to offer assistance to their employees as their location becomes tobacco-free.

Amy Hamilton Forester facilitates the FirstQuit program at Richmond Memorial Hospital and at various work sites throughout Richmond County. She completed the tobacco treatment specialist course at the University of Massachusetts.

According to Forester, it usually takes several attempts, often accompanied by different approaches, for a user to become tobacco-free.

“Many people who are trying to quit become discouraged if they slip up and have a couple puffs of a cigarette,” she said. “They feel like they have failed. In reality, it was only a slip and it doesn’t mean you have to go back to your normal smoking routine.

“There are so many myths out there concerning the use of nicotine replacement therapy (NRT),” added Forester. “In fact, if a person chooses to use an NRT, the chance of successfully quitting can double.”

In a recent expansion of the FirstQuit program, Moore Regional and Richmond Memorial hospitals have begun offering inpatient bedside consultations for tobacco-using patients. Miller says these efforts have put FirstHealth “ahead of the game” for the expected 2012 addition of inpatient tobacco-cessation programs to The Joint Commission’s list of performance measures for nationally accredited hospitals.

The effort takes the input and effort of many people.

“FirstHealth’s hospitalists and nursing staff have been instrumental in helping make the inpatient FirstQuit program a success and will be part of the process to make it stronger,” Miller said.

Forester also warned of the dangers of secondhand smoke, especially to children.

“There is no safe amount of smoke,” she said. “So many people, particularly caregivers of children, try to convince themselves that as long as a child isn’t sitting with them while they smoke, that it’s OK. We know that it’s not. Secondhand smoke lingers on hair, clothing, car seats and laundry. Children who are sensitive to this suffer.”

Former smoker Kellis, who no longer works for FirstHealth, said FirstQuit gave him the tools to give up his tobacco habit and quitting gave him the means to renew his interest in a pastime that he hadn’t enjoyed for a while.

He figures giving up cigarettes — at $5 or so a pack — has saved him more than $1,800 a year over the past 10 years.

“I think it paid for my motorcycle,” he said.

Today, Nov. 17, is the day of the Great American Smokeout.

Smokers are encouraged to use the 36^th Great American Smokeout as an opportunity to make a plan to quit smoking today. By doing so, according to the American Cancer Society, they will be taking an important step toward a healthier life — one that can lead to reducing cancer risk.

Tobacco-use remains the single largest preventable cause of disease and premature death in the United States, yet more than 46 million Americans still smoke. More than half of these smokers have attempted to quit for at least one day in the past year. According to health educators at FirstHealth of the Carolinas, that indicates a strong desire to quit.

Although quitting is difficult, tobacco-users can increase their chance for success with help. FirstHealth’s FirstQuit program is available to anyone in the community. Fees are based on income and range from $5 to $50.

To learn more about FirstQuit or how to enroll in the program, call 877-342-2255. For more quit-tobacco information, contact the NC Quitline at (800) QUITNOW (784-8689).