Engaging Culturally Competent, Community-Based Programs in Reducing Tobacco-Related Health Disparities

Abstract

Models of community-based health promotion and prevention programs are increasingly prominent as they seek to ensure active community participation and increase local capacity for engaging in prevention activities.1 US government health agencies, including the Centers for Disease Control and Prevention, recommend a focus on community-based prevention and control strategies, as exemplified by the Task Force on Community Preventive Services.2 Key elements of these models include engaging community coalitions in achieving program goals, implementing interventions beyond the borders of health care settings, and ensuring culturally competent approaches, such as the use of lay health advisors. Although these models have generated funding from both public and private sources, evidence suggests that health promotion programs involving coalitions may have had limited impact on community health status.1 That is, despite the conceptual strengths of community-based programs and a clear rationale for their continued support, evaluators have noted only modest individual-level results and limited population-level changes in health status outcomes.1 Nevertheless, community-based interventions have the potential to reach large numbers of people, enhance cultural competency in service delivery, and promote policies to improve public health and health care.3,4 Attempts to trace the value of community-based programs on population-level health behaviors and outcomes may be abetted by systems science approaches.5 The challenge of demonstrating the contribution of these programs may require refocusing the analysis on evaluating community-level outcomes and examining their role in a larger scheme of health care access and quality.