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IntroductionEvidence-based tobacco cessation interventions increase quit rates, yet most smokers do not use them. Every primary care visit offers the potential to discuss such options, but communication can be tricky for patients and provider alike. We explored smokers’ personal interactions with health care providers to better understand what it is like to be a smoker in an increasingly smoke-free era and the resources needed to support quit attempts and to better define important patient-centered outcomes.MethodsThree 90-minute focus groups, involving 33 patients from 3 primary care clinics, were conducted. Participants were current or recent (having quit within 6 months) smokers. Topics included tobacco use, quit attempts, and interactions with providers, followed by more pointed questions exploring actions patients want from providers and outcome measures that would be meaningful to patients.ResultsFour themes were identified through inductive coding techniques: 1) the experience of being a tobacco user (inconvenience, shame, isolation, risks, and benefits), 2) the medical encounter (expectations of providers, trust and respect, and positive, targeted messaging), 3) high-value actions (consistent dialogue, the addiction model, point-of-care nicotine patches, educational materials, carbon monoxide monitoring, and infrastructure), and 4) patient-centered outcomes.ConclusionEngaged patient-centered smoking cessation counseling requires seeking the patient voice early in the process. Participants desired honest, consistent, and pro-active discussions and actions. Participants also suggested creative patient-centered outcome measures to consider in future research.

We examined geographic and racial variation in cancer mortality within the state of Georgia, and investigated the correlation between the observed spatial differences and county-level characteristics. We analyzed county-level cancer mortality data collected by the Centers for Disease Control and Prevention on breast, colorectal, lung, and prostate cancer mortality among adults (aged ≥ 18 years) in 159 Georgia counties from years 1999 through 2019. Geospatial methods were applied, and we identified hot spot counties based on cancer mortality rates overall and stratified by non-Hispanic white (NH-white) and NH-black race/ethnicity. Among all adults, 5.0% (8 of 159), 8.2% (13 of 159), 5.0% (8 of 159), and 6.9% (11 of 159) of Georgia counties were estimated hot spots for breast cancer, colorectal, lung, and prostate cancer mortality, respectively. Cancer mortality hot spots were heavily concentrated in three major areas: (1) eastern Piedmont to Coastal Plain regions, (2) southwestern rural Georgia area, or (3) northern-most rural Georgia. Overall, hot spot counties generally had higher proportion of NH-black adults, older adult population, greater poverty, and more rurality. In Georgia, targeted cancer prevention strategies and allocation of health resources are needed in counties with elevated cancer mortality rates, focusing on interventions suitable for NH-black race/ethnicity, low-income, and rural residents.

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