Healthcare Providers: Tools and Resources
Healthcare providers can play a key role in fighting tobacco use, the number one cause of preventable death and disease in the United States. With tools and smoking cessation resources from the Tips From Former Smokers® (Tips®) campaign, you can ensure your patients have the right resources to begin their quit journeys.
- Treating Tobacco Use and Dependence: A Quick Reference Guide for Clinicianspdf iconexternal icon [PDF 1.07MB]. This quick reference guide summarizes the findings from the Treating Tobacco Use and Dependence, Clinical Practice Guideline: 2008 Updateexternal icon, including a summary of evidence-based cessation treatments and information for health care decision making.
- US Preventive Services Task Force (USPSTF) Tobacco Cessation Recommendationsexternal icon Read the USPSTF’s most recent recommendations for tobacco smoking cessation interventions for adults, including pregnant women.
- HIV Provider Smoking Cessation Handbook: A Resource for Providersexternal icon
- HIV & Tobacco Use: Pharmacologic and Behavioral Methods to Help Your Patients Quitpdf iconexternal icon [PDF – 282KB]
- The Community Guideexternal icon – The Guide to Community Preventive Services is a free resource to help you choose programs and policies to improve health and prevent disease in your community. It includes systematic reviews of tobacco prevention and control interventions, including for cessation and second-hand smoke exposure.
Posters featuring participants from the Tips From Former Smokers campaign are available to download and print in both English and Spanish. Posters tell patients “You can quit” and direct patients to talk to their healthcare team, dental team, pharmacist, HIV specialist, or child’s healthcare team. Use these posters in clinics, pharmacies, and waiting rooms to start conversations with patients about quitting.
CDC recognizes that health care providers play a crucial role in helping tobacco users quit. These health care providers include, but are not limited to:
- Physician assistants
- Dental hygienists
- Nurse practitioners
As Tips® ads show, tobacco use has a tremendous impact on patients’ overall health and their oral health. CDC hopes to reach out to health care providers in an inclusive way, knowing that each member of the health care team has an impact on their patients’ well-being.
Tobacco use is still the number one preventable cause of death and disease in the United States. It is a risk factor for heart disease, stroke, diabetes, cancer, and other common chronic diseases. The good news is that the majority of tobacco users say they want to quit, and nearly half try to quit each year. However, only 4% to 7% of smokers are successful in quitting each year. Brief advice from you significantly increases the chances that your patient will try to quit and do so successfully. Smokers cite health care professional advice to quit as an important motivator for attempting to stop smoking. You can make a difference!
Talking with your patients about quitting tobacco use has never been easier. A number of referral resources exist to support your work with patients, including the toll-free 1-800-QUIT-NOW quitline and 1-855-DÉJELO-YA for Spanish speakers. CDC’s Tips campaign Web site (Tips From Former Smokers(/tobacco/campaign/tips/index.html) or Consejos de exfumadores (/tobacco/campaign/tips/spanish/index.html)for Spanish speakers) can also be used as a resource for patients. In addition to information about the real people featured in the Tips From Former Smokers ads, the Tips web site includes information about quitting(/tobacco/campaign/tips/quit-smoking/quitting-resources.html) and a guide to help patients plan for a quit attempt(/tobacco/campaign/tips/quit-smoking/guide/index.html).
Want help on how to quit smoking? Call the quitline: 1-800-QUIT-NOW or visit How to Quit Smoking. Quitlines provide free and confidential coaching to help you become—and stay—smoke free. Calling a quitline might be just what you need to help you quit for good. Many thanks to the California Smokers’ Helpline for their participation in the creation of this video.
Quitlines are effective, evidence-based tobacco cessation interventions that help tobacco users quit through a variety of service offerings, including counseling, practical information on how to quit, referral to other cessation resources, and mailed self-help materials.1
- Are free
- Can be easily accessed by calling 1-800-QUIT-NOW
- Are confidential
- Overcome some of the barriers to seeking tobacco treatment, such as transportation, child care, financial or geographical barriers
- Tailor their help to meet the needs of individual callers
- Increase a tobacco user’s chances of successfully quitting (the 2008 update to the Public Health Service’s Clinical Practice Guideline Treating Tobacco Use and Dependence determined that quitlines increased the odds of 6-month abstinence by approximately 60%)2
- Are staffed by counselors who are highly trained health care professionals
Quitlines may offer a variety of other services, such as Web-assisted tobacco interventions and text messaging. They also offer information and support for family, friends, and health care professionals who want to help tobacco users quit.
Some state quitlines offer free cessation medications or provide tobacco users with vouchers or discounts to receive these medications at reduced cost. Most quitlines also offer counseling protocols and materials designed for specific populations, such as pregnant women or smokers with chronic diseases. For information on your state’s quitline services, visit NAQC Quitline Mapexternal icon. Simply click on your state to view the quitline profile page.
Quitlines are effective, evidence-based treatments for smoking cessation. The evidence base for tobacco cessation quitlines was established through numerous clinical trials and meta-analyses. After an exhaustive review of the randomized clinical trial research literature, the 2008 update to the Public Health Service’s Clinical Practice Guideline Treating Tobacco Use and Dependence concluded that quitlines increase 6-month smoking cessation quit rates compared with no intervention (the Guideline reported quit rates among quitline users of 12.7% for counseling alone and 28.1% for counseling plus medication) and therefore recommended the use of quitlines to help tobacco users quit.2 Quitlines have been shown to be a highly cost-effective intervention that deliver high value relative to their cost when compared with other common disease prevention interventions and medical treatments.3
Yes. All 50 U.S. states, the District of Columbia, Puerto Rico, and Guam operate quitlines that can be accessed through the 1-800-QUIT-NOW quitline (operated by the National Cancer Institute). This toll-free number automatically transfers callers to their state quitline. This easy-to-remember number allows for national promotion of quitline services. Health care professionals can refer patients who are interested in quitting to 1-800-QUIT-NOW.
When patients call the quitline they will be asked about their tobacco use, previous quit attempts, how they heard about the quitline, and some basic demographic questions, including gender, age, race/ethnicity, and education level. Citizenship documentation is not asked. This initial process usually takes about 10 minutes. All information collected is kept strictly confidential and is treated as protected health information.
Callers then receive information about the services the quitline offers. If a caller is interested in receiving mailed self-help materials, an address is taken and materials are typically shipped within 24 hours. If a caller would like referrals to local cessation services or information on Web-based cessation help, that information is provided. If a caller is interested in receiving cessation counseling, he/she is typically transferred to a tobacco cessation counselor. Cessation counselors are highly trained professionals who are skilled in motivational interviewing and delivering client-centered interventions. The counseling session, typically lasting about 30 minutes,4 may focus on creating a tailored quit plan, providing medication or decision support in choosing medications, and discussing tips and tools for overcoming everyday urges to smoke.
It is important to note that during times of heavy call volume (especially during national media campaigns that promote 1-800-QUIT-NOW), a cessation counselor may not be immediately available. In these cases, the quitline will schedule an appropriate call-back time with the caller.
The majority of states do not have eligibility criteria for providing quitline counseling beyond being a state resident. Many states also require that callers be interested in quitting tobacco in the next 30 days. However, some states may have more detailed eligibility criteria or may prioritize multiple call services or free medications for those meeting specific criteria (e.g., uninsured, Medicaid insured, etc.). For specific details on your state quitline’s eligibility criteria, visit NAQC Quitline Mapexternal icon. Click on your state to view the quitline profile page.
After asking if a patient uses tobacco and advising them to quit if they do, you will need to determine if they are ready to quit. For those patients who are not ready to quit, remind them that you have resources to help them quit when they are ready.
If a patient is ready to quit, you can refer them to your state quitline in one of two ways:
- Provide your patient with the 1-800-QUIT-NOW number and briefly explain what will happen when they call. This referral method requires your patient to make the initial call to the quitline. For example, you might say:
“I am happy to hear you are ready to quit and I want you to know that help is available. Our state has a telephone-based tobacco quitline that is free and offers help to people who want to quit. When you call you will be asked a few questions about yourself and your tobacco use and then you will have the opportunity to talk to a person who has been trained to help you develop a quit plan.”
- Use your state quitline’s proactive referral system. This referral method prompts the quitline to call your patient directly to start services. In most states, health care providers can send a referral with the patient’s contact information to the state quitline through a fax or an electronic health record. This typically involves briefly explaining to the patient what will happen when the quitline calls, obtaining the patient’s written consent to be contacted by the quitline, and faxing or electronically submitting the referral form. Many quitline referral programs offer feedback to referring providers to track patients’ progress. To learn more about the health care provider referral program in your state, visit NAQC Quitline Mapexternal icon. Click on your state to view the quitline profile page.
To learn more about conducting brief tobacco interventions, visit Medscape video (Conducting a Brief 2A & R Tobacco Intervention)external icon.
Quitlines play an important role in statewide comprehensive tobacco control programs. The majority of funding for state quitlines comes from state Master Settlement Agreement funds, state general funds, and state tobacco taxes.4 In addition, some quitlines have partnerships with health insurance plans and/or employers to offer qualifying callers with expanded quitline and cessation services. To learn more about how your state quitline is funded, visit Quitline Administration and Financingexternal icon.
You can refer Spanish-speaking patients who want to quit to 1-855-DÉJELO-YA (1-855-335-3569), which means “Quit it now.” This Spanish-language quitline, which is operated by the National Cancer Institute, functions similarly to 1-800-QUIT-NOW, with callers being automatically routed to their state quitline where they can receive services in Spanish.
The Asian Smokers’ Quitlineexternal icon, which is operated by the Moores Cancer Center at the University of California, San Diego, with funding from the Centers for Disease Control and Prevention, offers free nationwide telephone assistance for Chinese, Korean, and Vietnamese speakers who want to quit smoking.
To learn more about languages supported by your state’s quitline, including services provided to those who are deaf and hard-of-hearing, visit NAQC Quitline Mapexternal icon. Simply click on your state to view the quitline profile page.
- Ossip-Klein D, McIntosh S. Quitlines in North America: evidence base and applications. The American Journal of the Medical Sciences 2003;326(4):201–5.
- Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Quick Reference Guide for Clinicians. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. April 2009.
- Kahende JW, et al. A review of economic evaluations of tobacco control programs. International Journal of Environmental Research and Public Health 2009;6(1);51–68.
- North American Quitline Consortium. Results from the 2011 NAQC Annual Survey of Quitlines pdf icon[PDF – 1.20MB]external icon [accessed 2018 March 29].
- Rx for Change: Clinician-Assisted Tobacco Cessationexternal icon A comprehensive tobacco cessation training program for health professionals of all disciplines which aims to equip clinicians with evidence-based knowledge and skills for assisting patients with quitting tobacco use.
- Medscape video (Conducting a Brief 2A & R Tobacco Intervention)external icon An informational video featuring Tim McAfee, MD, former senior medical officer to CDC’s Office on Smoking and Health. This video shares the steps that you can take to conduct brief interventions with your patients.
- Medscape video – HIV and Smokingexternal icon John Brooks, MD, Leader of the HIV Epidemiology Research Team at the CDC’s Division of HIV/AIDS Prevention explains the added dangers of smoking with HIV, and what steps you can take to help your patients.
Pharmacy Partnership Shows How STRAND Has Helped Smokers Quit
CDC’s Office on Smoking and Health (OSH) has been partnering with STRAND (formerly Creative Pharmacist) since 2015 to promote smoking cessation in independent pharmacies across the country. STRAND supports and empowers independent pharmacists to work with patients to improve their overall health.
In 2016, STRAND partnered with OSH and West Virginia’s Department of Tobacco Control to launch a smoking cessation pilot program in five rural counties with high cigarette smoking prevalence. Fifty adult cigarette smokers enrolled in the program. According to STRAND, within ten weeks of launching the program, 40 percent of the enrolled patients had quit smoking, and one-third remained quit at 24 weeks. The program was expanded, with an additional eight rural pharmacies enrolling 110 patients, 30 of whom had quit cigarette smoking at 12 weeks.
Additionally, in 2016, Creative Pharmacist TV (an Apple TV app created by STRAND) placed ten Tips From Former Smokers® campaign television ads in 65 independent pharmacies. To date, these ads have played over 2 million times in the stores where a pharmacist is accessible for cessation support.
This partnership has helped provide local pharmacists with tools and resources to help their clients quit cigarette smoking.
- The American Psychiatric Association’s Practice Guideline for the Treatment of Patients With Substance Use Disorderspdf iconexternal icon [PDF – 2.86MB] (includes a section on nicotine dependence).
- Resources and Training for Behavioral Health Providers
- Smoking Cessation Leadership Centerexternal icon, University of California, San Francisco
- Center for Tobacco Research and Interventionexternal icon, University of Wisconsin
- Center for Integrated Health Solutionsexternal icon, SAMHSA-HRSA
- Tobacco Cessation Interventions and Smoke-Free Policies in Mental Health and Substance Abuse Treatment Facilities — United States, 2016
- Psychiatric Nurses as Champions for Smoking Cessationexternal icon from the American Psychiatric Nurses Association.
- Smoking and Mental Illnessexternal icon from the American Psychological Association.
- Policy statement developed by the Association for the Treatment of Tobacco Use and Dependence entitled “Integrating Tobacco Treatment Within Behavioral Health.pdf iconexternal icon” [PDF – 50KB]
- ADA-certified online dental courseexternal icon, produced by the Maricopa County Health Department in Arizona, that can help you learn how to help your patients quit using tobacco.
- American Dental Association – Smoking and Tobacco Cessationexternal icon
- Why it Matters to Dental Professionalspdf icon
- The 2014 Surgeon General’s Report: The Health Consequences of Smoking—50 Years of Progress documents eye diseases that are linked smoking, including age-relate macular degeneration and smoking. Chapter 10 pdf icon[PDF-5.2 MB]external icon specifically addresses these vision loss-related conditions.
- Prevent Blindnessexternal icon has several resources for vision care professionals and patients, including:
- The National Eye Instituteexternal icon has Healthy Vision Month resourcesexternal icon for use in your practice, as well as resources about conditions linked to smoking, including Facts About Cataractexternal icon and Facts About Age-Related Macular Degenerationexternal icon.
- CDC’s Vision Health Initiative promotes vision health and quality of life for all populations, through all life stages, by preventing and controlling eye diseases, eye injury, and vision loss resulting in disability.
General Health Systems Change for Tobacco Cessation
Million Hearts® Protocol for Identifying and Treating Patients Who Use Tobaccopdf icon[PDF–634 KB]external icon
Million Hearts® Guide: Identifying and Treating Patients Who Use Tobacco: Action Steps for Clinicianspdf icon[PDF– 351 KB]external icon
These two companion Million Hearts® tools contain practical information, action steps, and health system design considerations to enable health care providers to intervene effectively to help patients who use tobacco quit.
Using Health Systems Change to Increase Tobacco Cessation: What Can State Tobacco Control Programs Do? Frequently Asked Questions (FAQ) pdf icon[PDF– 159 KB]
This Frequently Asked Questions sheet is intended to provide state tobacco prevention and control managers with an overview about the basics of health systems change. This resource is meant to supplement information provided on this topic in the recent Best Practices Document.
Q&A with Harvard Vanguard Medical Associates and Atrius Health about Health Systems Change to Address Smoking pdf icon[PDF–484 KB]
Harvard Vanguard Medical Associates and Atrius Health respond to questions about an extensive health systems change effort they undertook in 2007 to improve tobacco dependence treatment in their health care system.
Louisiana State University Health System’s Tobacco Control Initiative pdf icon[PDF–1.84 MB]
This question and answer style case study provides an overview of Louisiana State University’s Health System’s Tobacco Control Initiative, focused on developing and implementing a systematic approach to treating tobacco use in one of the largest safety-net health delivery systems in the country.
Academic Detailing in Tobacco Cessation: Frequently Asked Questions pdf icon[PDF–142 KB]
Frequently asked questions related to the use of academic detailing as a training and education approach in tobacco control to reach health care providers and health systems.
Developing and Managing an Academic Detailing Program for Tobacco Cessation: Question and Answer with the Wisconsin Tobacco Prevention and Control Program (TPCP) and the University of Wisconsin Center for Tobacco Research and Intervention (UW CTRI) pdf icon[PDF–236 KB]
A question and answer with the Wisconsin Tobacco Prevention and Control Program and the University of Wisconsin about their more than ten years of experience running an on-the-ground academic detailing outreach program. Questions cover program development, implementation, management, and outcomes.
Arkansas’s Systems Training Outreach Program: Using Academic Detailing to Reach Health Care Providers pdf icon[PDF–164 KB]
A case study about how the Arkansas STOP program aligns with the Component Model of Infrastructure framework for evaluating tobacco control.
CDC Public Health Surveillance and Informatics Program Office Link on Meaningful Use
Resources, including fact sheets and recommendations related to the Meaningful Use program.
Quality Measures in Tobacco Cessation
Million Hearts® Clinical Quality Measures Dashboardexternal icon
This link includes information about the quality measure for tobacco assessment and treatment and a Clinical Measures Dashboard which displays data from select quality reporting initiatives at the state, HHS region, and national level.
The following organizations have partnered with the Tips From Former Smokers campaign to build awareness for tobacco prevention and cessation. The organizations are listed for identification purposes only and do not imply endorsement by the Centers for Disease Control and Prevention.
Allergy & Asthma Network (AAN)
AANexternal icon is a nonprofit organization whose mission is to end suffering and death due to asthma, allergies, and related conditions through outreach, education, advocacy, and research. Visit their Healthcare Professionals pageexternal icon.
American Academy of Family Physicians (AAFP)
Learn more about AAFP’sexternal icon Tobacco and Nicotine Program, which provides valuable resources on tobacco and nicotine prevention and control. The AAFP’s Tobacco and Nicotine Toolkitexternal icon offers resources to support tobacco and nicotine prevention and cessation.
American Academy of HIV Medicine (AAHIVM)
The AAHIVMexternal icon is a professional organization that supports the HIV practitioner and promotes accessible, quality care for all Americans living with HIV disease. Check out their Provider Resourcesexternal icon page.
American Academy of Pediatrics (AAP)
AAPexternal icon works to improve and develop healthcare policy for all children. Learn more about AAP’s Richmond Center of Excellence Clinician Resource Pageexternal icon that includes practice tools, coding and payment recommendations, training and CME courses, and other resources to help patients quit smoking.
American Academy of Physician Assistants (AAPA)
AAPAexternal icon is the national professional society for physician assistants (PAs). AAPA advocates and educates on behalf of the profession and the patients PAs serve.
American Association of Nurse Practitioners (AANP)
AANPexternal icon is the largest national membership organization for nurse practitioners (NPs) of all specialties. AANP works to empower all NPs to advance quality health care through practice, education, advocacy, research, and leadership.
American Association for Respiratory Care (AARC)
The AARCexternal icon is the national professional association for respiratory care. Learn more about the AARC’s tobacco resourcesexternal icon, including educational courses for respiratory therapists and a patient brochure for tobacco cessation.
American College of Cardiology (ACC)
American College of Nurse-Midwives (ACNM)
ACNMexternal icon is the professional association that represents certified nurse-midwives (CNMs) and certified midwives (CMs) in the United States. Learn more about ACNM and their commitment to Smoking Cessationexternal icon.
American College of Obstetricians and Gynecologists (ACOG)
ACOGexternal icon is a nonprofit organization of women’s health care physicians advocating highest standards of practice, continuing member education and public awareness of women’s health care issues. Review ACOG’s Smoking Cessation During Pregnancy Toolkitpdf iconexternal icon, a guide for clinicians to help pregnant women quit smoking.
American College of Physicians (ACP)
ACPexternal icon provides advocacy, practice tools, clinical guidance, CME and MOC for Internal Medicine and more. Learn more about ACP’s Smoking Cessation Resourcesexternal icon, which includes fact sheets for patients with online smoking cessation resources.
American Counseling Association (ACA)
ACAexternal icon is a not-for-profit, professional and educational organization that is dedicated to the growth and enhancement of the counseling profession. They feature several articles about smoking cessation and mental healthexternal icon on their website.
American Gastroenterological Association (AGA)
AGA’sexternal icon mission is to advance the science and practice of gastroenterology. Learn more about the AGA and its work to advance the science and practice of gastroenterology and read journal articlesexternal icon related to smoking and gastrointestinal health.
American Medical Association (AMA)
AMA’sexternal icon mission is to promote the art and science of medicine and the betterment of public health. Learn more about the resources and articles around smoking cessationexternal icon on their website.
American Osteopathic Association (AOA)
The AOA represents doctors of osteopathic medicine (DOs) and osteopathic medical students. Learn more about AOA’s smoking cessation resourcesexternal icon.
American Pharmacist Association (APhA)
APhAexternal icon, the largest association of pharmacists in the United States, aims to empower its members to improve medication use and advance patient care through information, education, and advocacy. Learn more about using the appointment-based model for expanding pharmacy-based tobacco cessation services on their websiteexternal icon.
American Psychiatric Association (APA)
The APAexternal icon is an organization of psychiatrists working together to ensure humane care and effective treatment for all persons with mental illness, including substance use disorders. Find resources on how to treat tobacco use disorder, including trainingexternal icon through the model curriculum project for substance use disorders.
American Psychiatric Nurses Association (APNA)
APNA is the largest professional membership organization committed to the specialty practice of psychiatric-mental health nursing and wellness promotion, prevention of mental health problems, and the care and treatment of persons with psychiatric disorders. Check out their Tobacco Dependence/Smoking Cessation Pageexternal icon with great resources to help behavioral health patients quit smoking.
American Psychological Association (APA)
APAexternal icon strives to ensure humane care and effective treatment for all persons with mental illness, including substance use disorders. APA’s Smoking Resourcesexternal icon site includes materials on health disparities and smoking such as webinars, fact sheets, and the APA SmokeScreen mobile appexternal icon for health care professionals with information on evidence-based practices for health priority populations.
Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN)
AWHONNexternal icon empowers and supports nurses caring for women, newborns, and their families through research, education, and advocacy. Read their position statement on Smoking and Women’s Healthexternal icon.
CHEST Foundation (CHEST)
The mission of the CHEST Foundationexternal icon is to champion lung health by supporting clinical research, community service, and patient education. Visit their Smoking and Tobacco Use Pageexternal icon for facts about tobacco use and smoking cessation.
The COPD Foundation’sexternal icon mission is to prevent and cure chronic obstructive pulmonary disease (COPD) and to improve the lives of all people affected by COPD.
The Foundation for Health Smart Consumers
The Foundation for Health Smart Consumersexternal icon provides information to help consumers make health care decisions.
Health Ministries Association (HMA)
HMAexternal icon encourages, supports and empowers leaders who integrate faith with the promotion of health and wholeness in local communities. HMA website also includes resourcesexternal icon, including publications and practice tools for reaching faith based audiences.
Laborers’ Health & Safety Fund of North America (LHSFNA)
LHSFNAexternal icon is committed to healthier laborers and healthier employer bottom lines. The LHSFNA’s Health Promotion Divisionexternal icon develops educational materials and information campaigns on tobacco cessation and other health and lifestyle issues that affect laborers and their families. They have a catalogueexternal icon of posters and other materials that warn about tobacco use that can be shared in offices or work areas.
Mental Health America (MHA)
MHAexternal icon is a community-based nonprofit organization dedicated to addressing the needs of those living with mental illness and to promoting the overall mental health of all Americans.
National Alliance on Mental Illness (NAMI)
NAMIexternal icon is dedicated to building better lives for the millions of Americans affected by mental illness.
National Association of Community Health Centers (NACHC)
NACHCexternal icon serves America’s medically underserved and uninsured and the community health centers that serve as their health care home.
National Association of Social Workers (NASW)
NASWexternal icon, one of the largest membership organizations of professional social workers, works to enhance the professional growth and development of its members and to create and maintain professional standards. Learn more about NASW’s practice tools for social workers, including smoking cessation resourcesexternal icon.
National Center for Primary Care (NCPC)
NCPCexternal icon is an academic research, training, and resource center focused on promoting excellence in community-oriented primary care and optimal health outcomes for all Americans, with a special emphasis on eliminating health disparities and improving health outcomes in underserved populations.
National Community Pharmacists Association (NCPA)
NCPAexternal icon represents independent community pharmacies across the United States. Look at their Smoking Cessation Services Pageexternal icon for tools on how pharmacists can help their patients quit smoking.
Prevent Blindnessexternal icon, the nation’s leading volunteer eye health and safety organization, dedicated to fighting blindness and saving sight. For more information on smoking and eye health, read their Smoking and Vision Fact Sheetpdf iconexternal icon.
The Wellness Council of America (WELCOA)
WELCOAexternal icon is a resource to help members build high-performing, healthy workplaces by helping business and health professionals improve employee well-being and create healthier organizational cultures.