Promoting Tobacco Cessation and Smoke-Free Workplaces Through Community Outreach Partnerships in Puerto Rico

Abstract

Background Puerto Rico (PR) has a lower smoking prevalence than the United States (14.8% vs. 21.2%, respectively); nevertheless, the five leading causes of death are associated with smoking. There is a need to implement evidence-based tobacco control strategies in PR. Objectives The Outreach Pilot Program (OPP) was designed to engage communities, health professionals, and researchers in a network to advance health promotion activities and research to increase the use of the PR Quitline (PRQ) among smokers and promoting policies in support of smoke-free workplaces. Methods Using community-based participatory research (CBPR) methods, the OPP mobilized a network of community and academic partners to implement smoking cessation activities including referrals to the PRQ, adoption of evidence-based smoking cessation programs, and promotion of smoke-free legislation. Results Eighty organizations participated in the OPP. Collaborators implemented activities that supported the promotion of the PRQ and smoke-free workplaces policy and sponsored yearly trainings, including tobacco control conferences. From 2005 to 2008, physician referrals to the PRQ increased from 2.6% to 7.2%. The number of annual smokers receiving cessation services through the PRQ also increased from 703 to 1,086. The OPP shepherded a rigorous smoke-free law through participation in the development, promotion, and implementation of the smoke-free workplaces legislation as well as the creation of the PR Tobacco Control Strategic Plan, launched in 2006. Conclusions This project demonstrates the feasibility of developing a successful and sustainable community-based outreach program model that enlists the participation of academic researchers, community organizations, and health care providers as partners to promote tobacco control.

Concept Analysis of Community Health Outreach

“…Also, the Community Outreach Heart Health and Risk Reduction Trial for high-risk subjects with primary or secondary cardiovascular events reported that telehealth lifestyle counseling was more effective at decreasing blood pressure or cholesterol than the recommended guideline for six months [28]. [29]. Similarly, the community outreach for smoking cessation in India was conducted [30].…”

Convergence as public health innovation: a case for tobacco control

“…Collaboration among multisector organizations is essential in addressing the gaps in tobacco control and other public health issues. 36 The absence of collaboration can constrict the reach and impact of public health initiatives. For instance, barriers to enforcement of illicit tobacco trade emerge from a lack of partnership and trust between different organizations and can be overcome by partnerships between health, marketing, and enforcement agencies.…”

“…34,46 Numerous studies mention community mobilization as a means to empower communities to impact social and health issues as well as an outcome of multisector collaboration. [30][31][32][33]35,36,44,45 It is a key enabler of convergent innovation especially in a technologically-savvy world where Internet and mobile connectivity facilitate better and quicker organization of communities. 18 Communities are best aware of their needs as well as their strengths, and once engaged, resourced, and mobilized, they can become an impetus for sustained convergent innovation and impact.…”

“…30,36,39 Partnerships with communities can directly address health inequities (beyond the impact of initiatives) by promoting social cohesion and increasing a sense of community identity. 30 Of note in the Healthy Cities Network, the proportion of partnerships was highest among tobacco control programs in comparison to food-related and alcohol/drug-related programs.…”

“…21 Capacity building is cited in numerous studies as a strong catalyst for partnerships as well as for community mobilization and empowerment. 33,36,45 The social learning phase strengthens the social capital that exists in the form of these partnerships. It also creates opportunities to address partner threats and anxiety through transparency.…”