Findings from Penn researchers indicate that conventional approaches to smoking cessation may actually be doing more harm than good: a trend that Associate Professor of Pulmonary Medicine Frank Leone is leading the charge to reverse.

Directed by Leone, who is also associate professor of medicine at Penn’s Perelman School of Medicine (PSOM), the Comprehensive Smoking Treatment Program is nationally recognized for its innovative data-driven methodology, respectful patient-centered approach, and unprecedented success. He and his interdisciplinary team of colleagues help more than 300 tobacco users work to achieve their cessation goals each year.

“All of us, smokers and non-smokers alike, are responsible for making sure that this epidemic—which kills nearly a half-million Americans each year—does not get propagated,” says Leone. “So at Penn, we’re doing everything we can to change the baseline assumptions and baseline conditions that have allowed the epidemic to go on for so long.”

One of these baseline conditions is that smoking be stigmatized.

“There’s no other condition, public health or otherwise, with which we have allowed ourselves the luxury of such severe stigma,” he says. “Tobacco dependence is a biological phenomenon and a public health epidemic, yet we’ve been relying on stigmatization to solve the problem.”

We assume the messages that smokers receive from anti-smoking campaigns are all about health impact, but, Leone says that the messages they hear “are really all about lack of respect, diminishment as a person, and an impingement on autonomy and self-determination; they’re not about health at all.”

So when Leone was asked to lead a task force in 2013 to make Penn a tobacco-less campus, he advocated for taking what he calls “a more respectful approach.”

“When people come to our clinic they already recognize the health impact of smoking and often feel ashamed and afraid. They don’t deserve that,” says Sarah Evers-Casey, associate director of the Comprehensive Smoking Treatment Program. “Our goal is to help them better understand the nature of addiction, relieve the burden of shame, and empower them to make important changes in their lives.”

Chris Hyson, senior health and wellness specialist at Penn’s Division of Human Resources, describes this approach as one that “focuses on intrinsic behavior change versus the usual mainstream approach of extrinsically shaping tobacco-related behavior through ‘tobacco-free’ policies, policing compliance, and punishing offenders.”

One way to affect behavior intrinsically, Leone says, is to communicate how smoking conflicts with the value systems upon which individual smokers base their decisions and behavior—values such as environmentalism, social justice, workforce preparation, or Penn citizenship, to name just a few.

Coming up with effective, creative solutions such as these takes more than the specialized knowledge of a pulmonologist.

“At Penn, there is a rich broth of people thinking about this kind of problem from lots of different perspectives, and all these folks really feed off each other,” says Leone.

Among them is Scott Halpern, PSOM associate professor of medicine, epidemiology, and medical ethics and health policy, and an expert in behavioral economics.

“It turns out that the most fundamental reason that people smoke,” says Halpern, “is because they are prioritizing pleasures today at the sacrifice of health tomorrow: a phenomenon known as temporal discounting.”

Halpern led the largest randomized trial ever that used financial incentives to counteract the steep temporal discounting curve that smokers are known to have. His team found that paying people to stop smoking in fact triples their quit rates—an intervention that beats any other ever tested.

Another important contributor to Penn’s cessation research is Caryn Lerman, professor of cancer research, senior deputy director of Penn’s Abramson Cancer Center, and co-director of the Penn Medicine Neuroscience Center. Among Lerman’s breakthrough discoveries is her identification of the “nicotine metabolite ratio,” which she describes as “a simple biomarker that captures genetic and environmental influences on nicotine metabolism.” It is the only biomarker known to definitively help doctors determine which type of cessation treatment will work best for each patient.

All told, Leone says, “Penn’s efforts match the complexity and the importance of the problem.”

And these efforts couldn’t be coming to fruition at a more opportune time, if the plethora of calls Leone has been fielding from other health systems is any indication.

“Because tobacco dependence has such a huge impact on community health,” he says, “understanding how to integrate it into the pay-for-performance model of health care that is starting to replace the fee-for-service model is going to be of critical importance.”

The goal of Penn’s cessation initiative is to positively impact the health of the global community as well as the campus community. Because of the magnitude of this goal, the methods Frank and his colleagues are developing and implementing are more than the conventional quick fixes.

“I can almost guarantee there is not another organization in the country that has taken this approach, this long-term view of culture change, to changing tobacco behaviors.”