Improving clinic- and neighborhood-based smoking cessation services within federally qualified health centers serving low-income, minority neighborhoods

Abstract

Within federally qualified health centers serving low-income, African American audiences, participatory approaches to system changes were organized through multidisciplinary committees that (a) drew on evidence-based guidelines, (b) guided system changes including the requirement of documenting smoking status and readiness to quit in encounter forms, (c) tested and refined practice improvements prior to their general adoption, and (d) guided development of neighborhood-based resources and supports for smoking cessation that were linked to clinic-based services. Documentation of smoking status or readiness to quit increased from 2% of encounter forms in the first 3 months to 94.3% in the last 3 months of the 24-month program. This rate remained over 90% throughout the following year. Exit interviews also indicated increased key clinic-based services, including "explained importance of quitting" (to 78% and 82% of interview respondents in the two intervention clinics in year 2), "tell you that you should quit" (to 80% in each), "tell you about nicotine gum...or other medications" (to 69% and 58%), "offer to help you quit" (to 61% and 64%), and "tell you about programs or help in your neighborhood" (to 51% and 56%). These rates exceeded those in one comparison clinic and equaled those in a second that also had launched a smoking cessation initiative. From exit interviews, improvements in neighborhood resources and support (e.g., people and activities that encourage nonsmoking) also exceeded those in comparison clinics. Thus, participatory approaches to system changes and quality improvement can enhance clinic- and neighborhood-based smoking cessation services within health centers serving low-income, minority populations.

Readiness to Quit Smoking in Rural Communities

“…Group counseling and counseling with a buddy have been successful strategies with African American smokers (Lawrence, Graber, Mills, Meissner, & Warnecke, 2003). A neighborhood-participatory approach was effective in improving cessation services in clinics serving low-income African Americans (Fisher et al, 2005). Paraprofessional community members served as smoking cessation coaches who made home visits, assessed readiness to change and provided one-to-one and group support.…”

Tobacco Smoking and Its Association with Illicit Drug Use among Young Men Aged 15-24 Years Living in Urban Slums of Bangladesh

“…The health behavior model of stress indicates that populations under stress generally engage in health detrimental behaviors, particularly in the context of low social status [43]. Based on this model, we could say that stressful conditions in slums [17] may lead to an increased risk of smoking and illicit drug use [23]–[25], [44], which is also evident from the higher prevalence of such risky behaviors among the slum youths compared to the youths in the country. Consistent with the health behavior model of stress [43] and other empirical studies [17], the likelihood of TS among youths in new settlements (like slums) is significantly (P<0.001) higher than the youths who lived in the same places since birth.…”

“…High stress tends to induce smoking [23] and deviations from normal lifestyles. The health behavior model of stress indicates that individuals under stress have a higher tendency to pick up health-detrimental behaviors like TS and IDU, which is more severe among those with low income and social status [24], [25]. Lack of social networking due to anonymity in the new environment and the absence of elderly family members to provide support among new rural-to-urban migrants are also factors that lead to adoption of risky lifestyles.…”

Black Versus White Differences in Rates of Addressing Parental Tobacco Use in the Pediatric Setting

“…36 Within the adult clinical setting, research shows pervasive disparities in providing tobacco cessation services to minorities. 37 Also, minority children, specifically black children, suffer disproportionate rates of health disparities compared to white children, with greater disparities seen in access to care, quality of healthcare, health status, and increased rates of mortality.…”