Tobacco Cessation Services Research Articles

Abstract A159: Data-driven strategies to develop materials to improve tobacco cessation services for Asian-American populations of Los Angeles County

Abstract BACKGROUND: Tobacco cessation stands as a pressing public health priority for cancer prevention, yet minority populations, including Asian Americans, encounter significant hurdles in quitting smoking. The Los Angeles County Tobacco Control and Prevention Program and the City of Hope Cessation Learning Collaborative join forces to tackle organization-level and individual-level barriers hindering the delivery, accessibility, utilization, and compliance of tobacco cessation interventions across diverse populations in Los Angeles County. Survey data gathered from healthcare providers and community members play a pivotal role in shaping the development and implementation of targeted tobacco cessation interventions. OBJECTIVES: To pinpoint gaps in tobacco cessation services for Asian/Asian American communities and develop tailored resources to address these deficiencies. METHODS: Data collection utilized: 1) Key Informant Interviews to delineate successes, barriers, and strategies in smoking cessation services for Asian/Asian American communities, 2) surveys with providers and healthcare staff serving these communities to identify critical factors contributing to challenges and barriers in providing cessation services, and 3) surveys with individuals within these communities to evaluate smoking history, tobacco product usage, access to cessation services, and barriers encountered. Collaborative partnerships with Community-Based Organizations (CBOs) serving Asian American communities were formed to conduct provider surveys. Findings from all surveys and interviews informed the development of culturally sensitive tobacco cessation training for healthcare providers. Behavioral mapping techniques and survey/interview findings guided the creation of a culturally appropriate capacity-building toolkit and tipsheets with recommendations to support tobacco cessation service implementation. RESULTS: Data collection comprised 5 Key Informant Interviews, 260 Surveys with Asian Serving Providers & Staff, and 1,070 Adult Tobacco Cessation Surveys among Asian/Asian American populations. Utilizing these findings, trainings were conducted, and resources developed for providers from 18 CBOs at Monthly Learning Collaborative Meetings. System-level findings informed the development of a capacity-building toolkit and tipsheets with recommendations to enhance tobacco cessation efforts in Asian American communities. CONCLUSIONS: Data-driven strategies are pivotal in tobacco cessation care. Through collaboration with CBOs and targeted interventions, tools can be fashioned to address culturally specific barriers to tobacco services. This learning collaborative initiative serves as a robust blueprint for developing data-driven strategies for equitable tobacco cessation services. Citation Format: Sophia Yeung, Alexis Garden, Brenda Gascon, Lauren D'Souza, Gaole Song, Jonjon Macalintal, Kimlin Ashing, Cary Presant, Gladis Chavez-Sosa, Cindy Song, Jonathan Tandoc, Jazmine Guillen, Lori Fischbach. Data-driven strategies to develop materials to improve tobacco cessation services for Asian-American populations of Los Angeles County [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A159.

Abstract C007: Building capacity in health clinics and community organizations serving LGBTQ+ communities on tobacco prevention

Abstract Background. Tobacco use remains a significant public health issue, particularly among the LGBTQ+ community. Los Angeles County, which is home to the second-largest LGBTQ+ population in the US, has notably higher prevalence of tobacco use compared to the general population, partly due to targeted marketing by the tobacco industry, social stressors, and discrimination. These factors contribute to higher rates of smoking and tobacco-related health disparities; however, little is known about the capacity of community-based organizations, clinical providers, support staff, and other personnel that work closely with the LGBTQ+ community to provide smoking cessation services. Methods. Cedars Sinai Cancer Center Community Outreach and Engagement (COE) assisted in the facilitation of conducting a needs assessment, Clinical Provider and Staff Survey, to assess the opinions of clinical providers and community leaders about tobacco cessation-related topics related to 1) Building culturally competent tobacco cessation services; 2) Reducing health disparities in tobacco cessation services; 3) Improving access to care (Medicaid/Medi-Cal access and uptake) for diverse populations that are affected by tobacco-related disparities; 4) Improving the utilization of tobacco cessation services. The survey was administered online from December 2022 to April 2023 with providers throughout Los Angeles County. Results. A total of 261 surveys were collected which revealed several key issues at the organization level: they do not prioritize tobacco screening, treatment, or referrals; there is no standardized process for client management; staff have limited knowledge on tobacco prevention and patient navigation; and there is limited staff capacity and funding. To address organizational-focused barriers, COE trained 147 clinical providers and staff from 4 local health clinics and organizations and on capacity building, including the basics of tobacco, evidence-based interventions like "Ask, Advice, Refer," and lung cancer screening. Additionally, to address Client/Patient-Focused Barriers for Organizations, such as: lack of motivation to quit, low perception of the severity of smoking, and a lack of culturally competent or targeted cessation resources, COE staff assisted in navigating resources, ensuring both providers and clients were aware of and could access relevant support services. This involved sharing LGBTQ+ affirming resources, including medical care, behavioral health, and housing, and referred smokers to gender-affirming cessation support groups. Conclusion. The survey highlighted the need to enhance service delivery and support for the LGBTQ+ community. With these findings, our COE staff were able to increase organizational capacity through training and education for clinical providers and staff to enhance their knowledge and skills in tobacco cessation and share gender-affirming resources and navigation, which are crucial towards improving the overall effectiveness of tobacco cessation services for LGBTQ+ populations. Citation Format: Victor Cristanto, Alexandra Caro, Reener Balingit, Zul Surani. Building capacity in health clinics and community organizations serving LGBTQ+ communities on tobacco prevention [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C007.

Barriers and facilitators to implementation of smoke-free area policy in public places: a scoping review

Enforcing laws requiring smoke-free areas in different locations is one way the government can lower cigarette consumption and exposure to cigarette smoke. The purpose of this study was, thus, to examine and summarize studies that identified facilitators and barriers to the implementation of a smoke-free area policy in public places. The researchers carried out systematic searches in December 2023 within these specific databases: Scopus, PubMed, ProQuest, Emerald Insight, and EBSCO and included studies on the implementation of smoke-free area policy that were published in English between 2018-2021. Out of the 684 research reports that were found, only 12 were accepted into the scoping study. The findings exhibited several barriers to the implementation of smoke-free area policy, including personal characteristics, the presence of tobacco sellers and smoking aids, lack of enforcement management, lack of support and collaboration from local government, lack of examples of policy implementation by local government, and no smoking signs or smoke-free policy signs. Meanwhile, the facilitating factors encompass fines and penalties, the presence of access to tobacco cessation services, smoke-free policy campaigns, and knowledge and attitudes toward smoke-free area policies. The evidence collected from the review’s findings suggests that there are more barriers than facilitating factors. This indicates that numerous adverse behaviors in the implementation of the smoke-free area policy are still present. The subsequent step following this study is to carry out primary research to thoroughly investigate the execution of the smoke-free area policy in public places.

Willingness to pay for a tobacco-free life: a contingent valuation assessment.

Tobacco, being an established risk factor for significant mortality and morbidity, causes over 7 million annual deaths globally. India is a country with over 270 million active tobacco users. On the one hand, although the willingness to quit amongst tobacco users is as high as 55.4%, the actual quit rates translate to less than 20%. Taking a cue from the economic principle of commitment and consistency, paying a nominal fee can serve as a form of public commitment and motivation to decrease the dropout rate amongst those committed to quitting. This study uses contingent valuation assessment to determine the willingness to pay (WTP) values for an effective tobacco cessation service across individuals with different socio-demographic characteristics. A cross-sectional observational study with multistage cluster sampling in Rajasthan was conducted to recruit 360 active tobacco users from 8 districts. Q-Q plots were used to determine the non-parametric distribution, and statistical differences between median WTP values were compared using Mann-Whitney U and Kruskal-Wallis H tests, considering a p-value less than 0.05 to be statistically significant. The majority of participants were males (57.78%) between the ages of 26 and 35 (40.28%), married (82.50%), and with children (65.83%), with an annual income between USD 7500-10,000 (23.61%) and graduate-level education (40.56%). Exclusive smokers formed the majority of the cohort (48.06%), and 50.83% were willing to quit as well as willing to pay for cessation. Median WTP values were maximum for males (USD 54.05; p<0.05), age group 26-35 years (USD 54.05; p<0.05), post-graduates (USD 81.08; p<0.05), and annual income above USD 20,000 (USD 121.62; p<0.05). Weak positive and significant correlations were observed between WTP and annual spending on tobacco, annual spending on health, and annual income. The study emphasizes the critical importance of early-age interventions for effective tobacco cessation prior to transitioning into dependency, resulting in reduced financial parity for availing health services. These are the first such WTP values from the Southeast Asian region, tailored for different population subsets, specifically for tobacco cessation. Our findings contribute to the growing body of evidence to support innovative approaches to enhance tobacco cessation efforts through financial commitments.

A Lost Opportunity in Tobacco Cessation Care: Impact of Underbilling in a Large Health System

IntroductionTobacco cessation remains a critical challenge in healthcare, with evidence-based interventions often under-utilized due to misaligned economic incentives and inadequate training. This study aims to quantify the economic impact of missed billing opportunities for tobacco cessation in a healthcare system, thereby assessing potential revenue loss and evaluating the effectiveness of systems-based approaches to enhancing tobacco cessation efforts. MethodsA retrospective cohort study utilized aggregated de-identified patient health data from an 8-hospital regional health system across Pennsylvania and Maryland, from 1/1/21 to 12/31/23. The analysis focused on primary care encounters eligible for tobacco cessation counseling (CPT codes 99406 or 99407), with potential revenue calculated based on the Medicare reimbursement rate. ResultsOver three years, and 507,656 office visits, only 1,557 (0.3%) of encounters with persons using tobacco were billed for cessation services. The estimated total potential revenue gained if each person who was identified as using tobacco was billed consistently for tobacco cessation counseling was $5,947,018.13, and $1,982,339.38 annually. ConclusionsThe study reveals a significant gap between the potential and actual billing for tobacco cessation services, highlighting not only the financial implications of missed opportunities but also a validation of a health system's public health impact. Underbilling contributes to considerable annual revenue loss and undermines primary prevention efforts against tobacco-related diseases. The findings illuminate the need for enhanced billing practices and systemic changes, including policy improvements that influence proper billing to promote public health benefits through improved tobacco cessation interventions.

Interest in Online Tobacco Cessation Services During the COVID-19 Pandemic in India- insights from Google Trends

Abstract Background: With concerns about higher mortality and morbidity attributed to COVID-19 infection among tobacco users, the pandemic has been an opportune time to further our efforts towards tobacco cessation. The present study thus aims to assess the interest in tobacco cessation services during the pandemic. Materials and Methods: An ecological study was done using data from Google Trends for five years. The trends depicting the interest in internet search terms like “Quit-tobacco” and “Quitline” were retrieved and compared over the study period and with the Global Adult Tobacco Survey-India (GATS-II) data estimates (2016–17). The results were reported using descriptive statistics and line graphs. Results: Between 2017 and 21, the search interest regarding quitting tobacco depicted the highest peak corresponding to the second wave of the COVID-19 pandemic. There were significant geographical disparities in the Google searches made across India. As per GATS-II, only 0.2% of the smokers had used a Quitline, corresponding to a smaller peak in Google Trends. Interest in “Quitline” compared to “quit tobacco” was in a ratio of 1:11, and the gap increased further during the pandemic by 1:12. Conclusions: We observed an increasing interest in the searches related to “Quit-tobacco” like terms during the pandemic but an increasing gap in the interest around the “Quitline” searches. The present study hypothesizes that the pandemic increased concerns regarding tobacco, leading to a higher interest in tobacco cessation services, thus calling for a proactive approach to propagate ‘Quitline’ through generous advocacy to have efficient tobacco control per the National Tobacco Control Program.

Clinician attitudes toward referring patients to pharmacists for tobacco cessation services

BackgroundThe role of pharmacists in tobacco cessation has grown substantially in recent years, now including the ability to prescribe medications in many states. Although pharmacists can fill a gap in care by helping patients quit, other clinicians’ perceptions regarding referring patients to pharmacists for these services have not been described. ObjectiveTo characterize clinicians’ current referral patterns to pharmacists for tobacco cessation services, intention to refer in the future, and perceived barriers to and facilitators of referrals. MethodsA cross-sectional survey was administered within a network of federally qualified health centers (FQHCs), which provides care to underserved patients. Guided by the Consolidated Framework for Implementation Research (CFIR), the survey assessed (a) clinicians’ sociodemographics, (b) interactions with pharmacists and referral practices, and (c) perceived barriers to and facilitators of patient referrals to network pharmacists for cessation assistance. ResultsOf 51 respondents (80% response), one third (n = 17) reported referring one or more patients to a FQHC network pharmacist in the past for help with quitting tobacco. Most (84%) reported willingness to refer patients to pharmacists in the future, and 100% of the 17 clinicians who had previously referred patients strongly agreed that they would refer again in the future. For 8 of 12 CFIR measures (67%), significant differences were observed between clinicians who had previously referred patients to pharmacists and clinicians who had not. ConclusionNonpharmacist clinicians in an FQHC expressed positive views toward a pharmacist-led tobacco cessation service, and prior experience with referrals was consistent with strong intentions for future referrals. Future studies should explore concerns regarding impact on workflow to identify and implement strategies for streamlining referrals for cessation services.

Initial leadership concerns and availability of tobacco cessation services moderate changes in employee-reported concerns about tobacco-free workplace policy implementation over time.

Tobacco-free workplace policies (TFWPs) are underused evidence-based interventions that reduce the elevated use of tobacco among substance use treatment center (SUTC) employees and patients. SUTC employees' anticipated concerns about stakeholder pushback are barriers to TFWP adoption. Examination of discrepancies between anticipated and actualized employee-reported TFWP concerns arising from coworkers, patients, and community members in the context of leadership concerns and tobacco cessation care availability for employees may inform strategies to increase TFWP uptake. This study analyzed changes in employee-reported TFWP concerns from before to after a comprehensive tobacco-free workplace intervention that included TFWP implementation, using Chi-square/Fisher's exact tests. Preimplementation leadership policy concerns and tobacco cessation care availability were examined as moderators in generalized linear mixed models. Overall, 452 employees and 13 leaders provided data from 13 SUTCs collectively serving >82 000 patients annually. Results revealed significant decreases over time in employee-reported concerns about TFWP resistance from coworkers. Moderation analyses indicated that employee-anticipated concerns from coworkers and patients, respectively, were less likely to be actualized in SUTCs where leadership endorsed preimplementation TFWP concerns, whereas employee-reported patient concerns rose over time in SUTCs where leadership had no initial implementation concerns. Additionally, employee-anticipated concerns from coworkers were overestimated in SUTCs that did not offer tobacco cessation care to employees. Results supporting the nonactualization of anticipated employee concerns following TFWP implementation can be used to engage other SUTCs for TFWP adoption. Furthermore, moderation effects may suggest that center characteristics translate to greater attention to rollout, ultimately enhancing TFWP stakeholder acceptance.

Closing the Tobacco Treatment Gap: A Qualitative Study of Tobacco Cessation Service Implementation in Community Pharmacies.

Tobacco use remains a leading preventable cause of morbidity and mortality, with pharmacotherapy and counseling recognized as effective cessation aids. Yet, the potential role of pharmacists and pharmacy technicians in tobacco cessation services is underutilized. This study explores the integration of such services in community pharmacies, identifying facilitators and barriers to their implementation. A qualitative study was conducted across seven community pharmacies in California that were affiliated with the Community Pharmacy Enhanced Services Network. Participants included 22 pharmacists and 26 pharmacy technicians/clerks who completed tobacco cessation training. Data were collected through semi-structured interviews, focusing on experiences with implementing cessation services. The analysis was guided by Rogers' Diffusion of Innovations Theory. MAXQDA software was used for data management and thematic analysis. Sixteen pharmacy personnel participated in the study, highlighting key themes around the integration of cessation services. Compatibility with existing workflows, the importance of staff buy-in, and the crucial role of pharmacy technicians emerged as significant facilitators. Challenges included the complexity of billing for services, software limitations for documenting tobacco use and cessation interventions, and gaps in training for handling complex patient cases. Despite these barriers, pharmacies successfully initiated cessation services, with variations in service delivery and follow-up practices. Community pharmacies represent viable settings for delivering tobacco cessation services, with pharmacists and technicians playing pivotal roles. However, systemic changes are needed to address challenges related to billing, documentation, and training. Enhancing the integration of cessation services in community pharmacies could significantly impact public health by increasing access to effective cessation support.

CMS releases tobacco cessation bulletin

The Centers for Medicare and Medicaid Services' Center for Medicaid and CHIP [Children's Health Insurance Program] Services on March 7 released a new informational bulletin, “Strategies to Improve Delivery of Tobacco Cessation Services.” The purpose of this informational bulletin is to highlight strategies that states have used to improve the delivery of tobacco cessation services to help more Medicaid and CHIP beneficiaries quit smoking. The bulletin includes an overview of state tobacco cessation coverage requirements and authorities in Medicaid and CHIP and outlines the benefits of helping beneficiaries quit smoking. Smoking is the leading preventable cause of disease and death in the United States, causing about 480,000 deaths annually and costing more than $600 billion each year in direct medical care and lost productivity, according to the bulletin. Tobacco use is particularly salient for the populations enrolled in Medicaid. In 2021, approximately one in five (21.5%) adults who were enrolled in Medicaid smoked cigarettes, compared to about one in nine (8.6%) adults with private health insurance and about one in 10 (11.5%) adults overall.

Barriers to seeking tobacco cessation services: a qualitative assessment of university students' needs in Qatar.

The prevalence of tobacco use in the Middle East is alarmingly high, especially among university students; most users initiate tobacco use during adolescence and young adulthood. Evidence-based cessation services can be beneficial when quitting tobacco use; however, these services are underutilized. This study aimed to explore the barriers preventing university students in Qatar from seeking tobacco cessation services. Semi-structured interviews were conducted with 20 Qatar University students who are current or former tobacco users (n = 18/2); most current cigarette smokers were also waterpipe users. The interviews were transcribed verbatim, coded, and analyzed using thematic analysis. The major barriers to seeking tobacco cessation services included misconceptions regarding nicotine addiction, negative perceptions of the cessation services' effectiveness, self-efficacy regarding the ability to quit without seeking cessation services, concerns and preferences regarding practitioners' characteristics at clinics, masculine culture that discourages men from seeking cessation help, social stigma around women who use tobacco in Arab culture, and a lack of time to visit cessation clinics. Our findings address gaps in the literature regarding the individual and sociocultural barriers to seeking tobacco cessation among youth in Qatar. A better understanding of these barriers can facilitate successful promotion of tobacco cessation services and enhance cessation-seeking behaviors.

A Christian Faith-Based Facebook Intervention for Smoking Cessation in Rural Communities (FAITH-CORE): Protocol for a Community Participatory Development Study.

Tobacco smoking remains the leading cause of preventable morbidity and mortality in the United States, with significant rural-urban disparities. Adults who live in rural areas of the United States have among the highest tobacco smoking rates in the nation and experience a higher prevalence of smoking-related deaths and deaths due to chronic diseases for which smoking is a causal risk factor. Barriers to accessing tobacco use cessation treatments are a major contributing factor to these disparities. Adults living in rural areas experience difficulty accessing tobacco cessation services due to geographical challenges, lack of insurance coverage, and lack of health care providers who treat tobacco use disorders. The use of digital technology could be a practical answer to these barriers. This report describes a protocol for a study whose main objectives are to develop and beta test an innovative intervention that uses a private, moderated Facebook group platform to deliver peer support and faith-based cessation messaging to enhance the reach and uptake of existing evidence-based smoking cessation treatment (EBCT) resources (eg, state quitline coaching programs) for rural adults who smoke. We will use the Integrated Theory of Health Behavior Change, surface or deep structure frameworks to guide intervention development, and the community-based participatory research (CBPR) approach to identify and engage with community stakeholders. The initial content library of moderator postings (videos and text or image postings) will be developed using existing EBCT material from the Centers for Disease Control and Prevention Tips from Former Smokers Campaign. The content library will feature topics related to quitting smoking, such as coping with cravings and withdrawal and using EBCTs with faith-based message integration (eg, Bible quotes). A community advisory board and a community engagement studio will provide feedback to refine the content library. We will also conduct a beta test of the intervention with 15 rural adults who smoke to assess the recruitment feasibility and preliminary intervention uptake such as engagement, ease of use, usefulness, and satisfaction to further refine the intervention based on participant feedback. The result of this study will create an intervention prototype that will be used for a future randomized controlled trial. Our CBPR project will create a prototype of a Facebook-delivered faith-based messaging and peer support intervention that may assist rural adults who smoke to use EBCT. This study is crucial in establishing a self-sufficient smoking cessation program for the rural community. The project is unique in using a moderated social media platform providing peer support and culturally relevant faith-based content to encourage adult people who smoke to seek treatment and quit smoking. PRR1-10.2196/52398.

Development of a Virtual Human for Supporting Tobacco Cessation During the COVID-19 Pandemic.

People who consume tobacco are at greater risk of developing severe COVID-19. Unfortunately, the COVID-19 pandemic reduced the accessibility of tobacco cessation services as a result of necessary social restrictions. Innovations were urgently needed to support tobacco cessation during the pandemic. Virtual humans are artificially intelligent computer agents with a realistic, humanlike appearance. Virtual humans could be a scalable and engaging way to deliver tobacco cessation information and support. Florence, a virtual human health worker, was developed in collaboration with the World Health Organization to remotely support people toward tobacco cessation during the COVID-19 pandemic. Florence delivers evidence-based information, assists with making quit plans, and directs people to World Health Organization-recommended cessation services in their country. In this viewpoint, we describe the process of developing Florence. The development was influenced by a formative evaluation of data from 115 early users of Florence from 49 countries. In general, Florence was positively perceived; however, changes were requested to aspects of her design and content. In addition, areas for new content were identified (eg, for nonsmoker support persons). Virtual health workers could expand the reach of evidence-based tobacco cessation information and personalized support. However, as they are a new innovation in tobacco cessation, their efficacy, feasibility, and acceptability in this application needs to be evaluated, including in diverse populations.

Abstract A004: Quitxt mobile text messaging cessation program for primary care and cancer patients development and implementation process

Abstract Background: Physicians have unparalleled access to smokers. It is estimated that over 70% of smokers visit a physician every year, which provides a powerful opportunity to promote tobacco cessation by asking about smoking behaviors and providing cessation advice and counseling to tobacco users at every visit. In general, smokers consider a physician’s advice to quit an important motivator to make a quit attempt. Every patient is screened for tobacco use; if the patient is a tobacco user, healthcare providers (HCPs) advise them to quit, offer nicotine replacement therapy if needed, and recommend enrollment in the Quitxt program to receive daily messages from the program as well as patient navigator support. Purpose: To conduct a system change to facilitate the integration of Quitxt into the healthcare setting of the Primary Care Center (PCC) and the Mays Cancer Center (MCC) at UT Health San Antonio, to increase accessibility and utilization of a bilingual, evidence-based tobacco cessation service among patients. Methods: We adapted our Quitxt program to the patient population attending the PCC and MCC, integrated it into EPIC, and added it to the Best Practice Advisories Banner. All patients are screened for tobacco use, and if a tobacco-using patient is identified, the Best Practice Advisories banner appears on HCPs’ screen, prompting them to counsel patients to quit and encourage them to enroll in Quitxt. Enrollment cards are available in exam rooms and help providers talk about the program and provide information on how to enroll. The EPIC system also places instructions on how to enroll in Quitxt in the patients’ after-visit summary. Selecting referral to Quitxt activates our Patient Navigators (PNs) follow-up. PNs contact patients monthly and provide support, positive reinforcement, and encouragement. They continue with monthly follow-ups throughout the duration of the program (6 months). Results: To date, 194 patients have been referred to the BestPractice basket. PNs made 829 follow-up phone calls. Of those patients, 104 have enrolled in the program. So far, 96% are English speakers, with a mean age of 47 yrs (SD 11.4); 64% female, 38% Hispanic, the mean number of cigarettes smoked per day was 12, and 60% were ready to make a quit attempt the next day. Preliminary results show cessation rates of 22.1% at day 1; 26.2% at 7 days; 20.4% at 1 month; 31.4% at 4 months and 27.6% at 6 months. Conclusion: Integrating Quitxt into the healthcare setting increases the accessibility and utilization of the Quitxt cessation service among primary care and cancer patients. Quitxt can be easily replicated and represents an affordable approach to reach tobacco-using patients, produce a public health impact, and reduce health service costs and tobacco-related diseases and mortality. Citation Format: Patricia Chalela, Vivian Cortez, Sandra G. Sivak, Armida Flores, Edgar Muñoz, Cliff Despres, Ramon Cancino, Mio Kitano, Rahul Mundlamuri, Ganesh R. Gunnam, David Akopian, Amelie G. Ramirez. Quitxt mobile text messaging cessation program for primary care and cancer patients development and implementation process [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A004.

Patterns of tobacco use among patients visiting primary health centers in India: An exploratory study

Abstract Background: Tobacco is a public health concern at global and national levels. The state of Gujarat has 28.6% prevalence of tobacco use, 22% in males and 8% in females. Rajkot, the fourth largest and fastest growing city in Gujarat, is not free from the burden of tobacco use. Aim: The aim of this study was to assess the patterns of tobacco use and utilization of tobacco cessation services in the city of Rajkot. Methodology: This was a cross-sectional observational study conducted on adult tobacco users attending rural and urban primary healthcare centers (PHCs) in Rajkot. At least 16 participants were recruited from all 75 PHCs (a total of 1152) using probability sampling. Study instruments comprised semi-structured proforma, Fagerstrom Test for Nicotine Dependence, and readiness to change questionnaire. Responses were analyzed using SPSS version 26.0. Results: A total of 1161 participants were included. Smokeless tobacco (n = 967, 83.3%) was preferred over smoking. Mava was the most common smokeless tobacco preparation consumed. The median age of onset was 28 years (interquartile range [IQR]: 22–37), and the median duration of use was 5 years (IQR: 4–10). Males had a significantly greater duration of abstinence (U = 1218.6, P = 0.002), greater readiness to quit (χ 2 [df] = 35.66 [8], P = 0.001), and anticipated success (χ 2 [df] = 28.71 [8], P = 0.004) in abstaining. While utilization of tobacco cessation services was poor overall, counseling (32.5%) and nicotine replacement therapy (19%) were the most commonly used. Conclusion: There is a need for in-depth research on tobacco use among smaller communities, upscaling harm reduction services for tobacco use. Prevention and IEC initiatives need to be revamped considering the special needs of female tobacco users.

Evaluation of Feasibility and Acceptability of a Text-Messaging Intervention for Tobacco Cessation in India.

The aim of our study was to assess the feasibility and acceptability of a brief behavioral intervention for tobacco cessation delivered via mobile phone text messaging in India. We conducted an uncontrolled intervention cohort study in adult current users of tobacco. The participants received intervention messages on their mobile phones for eight weeks. We collected qualitative data about participants' perceptions of intervention delivery and receipt, acceptability, and feasibility of the intervention. The outcomes measured at 3 months post-recruitment were self-reported 7- and 28-day point-prevalence abstinence, and Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) risk categories for tobacco-low (0-3), moderate (4-26), and high (≥27). We recruited 26 eligible participants, and 22 completed the outcome assessments. The participants generally perceived the intervention content to be simple to access and useful in facilitating a change in tobacco use. None of the participants indicated that they wanted to discontinue receiving the intervention messages. Some suggestions for enhancing acceptability included supplementing text messaging with more intensive counseling and the use of multimedia content. Eighteen percent of participants reported abstinence in the past 7 and 28 days. A greater proportion of those who used smokeless tobacco were abstinent at follow-up compared to those who smoked (42.9% vs. 6.7%; p = .04). If effective, simple and low-cost mobile phone text messaging can be used to deliver interventions for tobacco use, and has the potential to be scaled up so it can be delivered to populations of smokers interested in receiving cessation support. Our study is an important step towards the development of a contextually relevant intervention suited for low- and middle-income countries and which is responsive to the needs of both those who use smoked and smokeless tobacco. If found to be effective, our intervention would be a scalable solution to overcome the human resource related barrier to accessing tobacco cessation services in low resource settings.

Factors associated with the implementation of a comprehensive tobacco cessation benefit among California Medicaid managed care plans

AbstractAlthough tobacco control efforts have been successful at reducing the rate of tobacco use in the general population, rates of use among low‐income populations persist. As a leader in tobacco control efforts, the U.S. state of California recently issued regulations regarding comprehensive tobacco cessation service requirements for state Medicaid plans (i.e., Medi‐Cal MCPs) providing health care to low‐income Californians. This research aims to evaluate the potential factors associated with the adoption of a comprehensive tobacco control program among Medi‐Cal's MCPs. In 2018, UC San Diego researchers distributed a survey to a listserv of 25 Medi‐Cal MCP health educators, for a response rate of 96%. The survey was comprised of questions related to All Plan Letter (APL) implementation of tobacco cessation services and policies. Health educators were also recruited to participate in a semi‐structured interview upon survey completion. Two years postrelease of the APL, Medi‐Cal's MCPs demonstrate low implementation of tobacco cessation services and related policies, with only one MCP (5%) fully implementing all 10 core provisions. Five consistent patterns were identified as being associated with implementation: larger MCP enrollment and staffing, lower median household income, noncapitated provider payment, participation in county tobacco control meetings, and high‐quality scores for preventive care and treatment of chronic disease. Small‐sized MCPs have been slow in fully implementing tobacco cessation services. State policymakers and tobacco control stakeholders may consider providing support to small‐sized MCPs to aid in their continued adoption of comprehensive tobacco cessation services. DHCS should also consider releasing guidance on how to engage in activities to ensure APL compliance.

Assessing the Feasibility of Conducting Smoking Cessation Outreach in Food Pantries: A Pilot Intervention Study.

Smoking prevalence is high among US adults with food insecurity. This study examined how food assistance settings, namely food pantries, can serve as a community-based venue to reach food insecure adults who smoke for smoking cessation. Partnering with a local hunger relief organization, we conducted surveys and focus groups of food pantry clients in Greater Cleveland, Ohio, followed by food pantry-based outreach events to connect people who smoke to the Ohio Tobacco Quit Line. The survey included 132 participants who visited a food pantry (M age = 47; 74% women; 39% Black/African American), of whom 35% were using tobacco and 31% were smoking cigarettes. Among those currently smoking (M cigarettes/day = 9), 76% intended to quit in the next 6 months, and 82% had not used nor heard of the quitline. Informed by focus group themes, we conducted a total of 22 outreach events at four pantries. Among those interested in smoking cessation resources from the outreach events (n = 54), 78% were able to be subsequently contacted. Of them, 74% provided consent for quitline referral. The remainder either declined or were unable to participate. While it was feasible to leverage food pantries for smoking cessation outreach, the overall reach was low. Despite high interest in quitting, there was limited effectiveness of outreach efforts without adaptations to each pantry setting and in recognition of the immediate food needs and with challenges related to the COVID-19 pandemic. There remains a critical need to address high rates of smoking among populations experiencing food insecurity. Tobacco cessation services are increasingly recognizing the need to address food insecurity and other social needs that commonly occur in populations who use tobacco at higher rates. This research underscores both the value and the challenges related to leveraging food pantries as a community-based venue for smoking cessation outreach. In addition to improvements in outreach models, long-term investments in structural interventions are also needed to address underlying poverty and socioeconomic disadvantage that ultimately drive disparities in smoking and in food insecurity.

Determinants of quit attempts among current Indian tobacco users: Findings from global Adult tobacco survey, 2016-17

Problem consideredTobacco use is the second most common preventable cause of death in the world and quitting tobacco is an important strategy to prevent premature morbidity and mortality. The objective of this study was to determine the correlates of quit attempts among tobacco users in India from GATS-2 data. MethodsComplex sample analysis was considered for logistic regression analysis to identify the correlates of quit attempts using Global Adult Tobacco Survey (GATS)- 2 (2016–17) data. Weighted estimates were calculated for sample statistics. ResultsA marked difference was observed in quit attempt rates across various states of India (p < 0.001). The quit attempt rate among current smokers and smokeless tobacco users was 33.7% [95% confidence interval (CI) = 32.8–34.7] and 28.9% [95% CI = 28.1–29.6] in India as per GATS 2. Individuals from scheduled caste and other backward classes had higher odds of making a quit attempt among current smokers. Among the smokeless tobacco users (SLT), factors namely age, belonging to other backward classes and having a belief that tobacco use is dangerous to health were independently associated with quit attempts. Majority of the users, 83.5% (95%CI = 82.2–84.8) of the smokers and 88%(95%CI = 87.0–88.9) of the SLT users made a quit attempt without any cessation aid. ConclusionFormulating tobacco control policies specific to the groups identified may bridge the gap between tobacco users and cessation services. The varying quit attempt rates reported across the country necessitates stringent implementation of tobacco control policies and programmes.

Texas tobacco quitline knowledge, attitudes, and practices within healthcare agencies serving individuals with behavioral health needs: A multimethod study

Patients with behavioral health conditions have disproportionately high tobacco use rates and face significant barriers to accessing evidence-based tobacco cessation services. Tobacco quitlines are an effective and accessible resource, yet they are often underutilized. We identify knowledge, practices, and attitudes towards the Texas Tobacco Quitline (TTQL) within behavioral healthcare settings in Texas. Quantitative and qualitative data were collected in 2021 as part of a statewide needs assessment in behavioral healthcare settings. Survey respondents (n = 125) represented 23 Federally Qualified Health Centers, 29 local mental health authorities (LMHAs), 12 substance use treatment programs in LMHAs, and 61 standalone substance use treatment centers (26 people participated in qualitative interviews).Over half of respondents indicated familiarity with the TTQL and believed that the TTQL was helpful for quitting. Qualitative findings reveal potential concerns about inconsistency of services, long wait time, and the format of the quitline. About half of respondents indicated that their center promoted patient referral to TTQL, and few indicated that their center had an electronic referral system with direct TTQL referral capacity. Interview respondents reported overall lack of systematic follow up with patients regarding their use of the TTQL services.Findings suggest the need for (1) increased TTQL service awareness among healthcare providers; (2) further investigation into any changes needed to better serve patients with behavioral health conditions who use tobacco; and (3) electronic health record integration supporting direct referrals and enhanced protocols to support patient follow up after TTQL referral.