Cigarette smoking remains the number one cause of preventable morbidity and mortality in the United States (US). Up to 24.3% of the 1.3 million adults who live in Public Health Regions 4/5 North (i.e., Northeastern Texas) use tobacco products. Texans in this region are older, of lower economic status, have less healthful lifestyles, and higher cancer-related death rates than for Texas. National data revealed Texans enrolled in Medicare had one of the lowest utilization rates of smoking cessation efforts in the US.

In preparation for this proposal, applicants met face-to-face with leadership from the 11 sites in Northeast Texas that provided letters of commitm...

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Cigarette smoking remains the number one cause of preventable morbidity and mortality in the United States (US). Up to 24.3% of the 1.3 million adults who live in Public Health Regions 4/5 North (i.e., Northeastern Texas) use tobacco products. Texans in this region are older, of lower economic status, have less healthful lifestyles, and higher cancer-related death rates than for Texas. National data revealed Texans enrolled in Medicare had one of the lowest utilization rates of smoking cessation efforts in the US.

In preparation for this proposal, applicants met face-to-face with leadership from the 11 sites in Northeast Texas that provided letters of commitment about offering cessation services. The interaction served to obtain leadership input and learn their perceptions for launching the cessation program in their settings. This experience was valuable since it provided clarity in learning about the currently used cessation interventions at the sites and referrals/electronic health record functionality.

Across the sites,we examined factors such as patient flow, obtained initial views of staff interaction with tobacco users, discussed site strategies for developing a provider feedback loop about patients referred to cessation, and met key individuals such as champions and quality improvement coordinators. These efforts upfront will help the applicants to be well-positioned to take the steps of providing assistance, supporting and working with each site to increase capacity as needed. Leaders at sites verbalized readiness to enact training of clinicians, ramp up treatment of tobacco dependence and put the program into practice.

The University of Texas, Department of Behavioral Science at MD Anderson Cancer Center (MDACC) has partnered with The University of Texas Health Science Center at Tyler (UTHSCT) to prepare the application and increase tobacco cessation in the region. MD Anderson Cancer Center tobacco treatment counselors will provide intensive care to patients referred. This will include 10 weeks of nicotine replacement therapy, 68 supportive text messages and 11 phone calls offering behavioral support. Evaluation of a similar dissemination program indicated 38.6% rates of cessation. This was among low-income adults at 6-month follow up.

A focus on offering continuing education about evidence-based interventions for treating tobacco dependence can equip at least 365 providers in Public Health Regions 4/5 North to screen tobacco users and offer referral to intensive tobacco cessation. Estimates indicate there are up to 30,000 encounters with tobacco users annually in the 11 sites. Reach of the intervention will be achieved by developing a patient referral process fitting operations at implementation sites.

The cessation program elements will include online and/or onsite provider training based on the “5 As” guideline (i.e., ask, advise, assess, assist and arrange). Patients asked about willingness to quit will be referred to the evidence-based tobacco cessation program. Staff at MD Anderson will be responsible for arranging participant follow-up calls to maximize quit attempts, tracking data about nicotine replacement use and cessation outcomes among participants until 6-month follow up. The evaluator, Dr. Yuan, Professor of Biostatistics will examine program outcomes (i.e., provider training and cessation rates).

Specific goals: 1) To offer training for clinicians titled “Tobacco & Nicotine Counseling for Adults and Adolescents.” This training is available online, provides continuing medical education credits and is designed to increase clinician abilities, confidence, and intention to counsel patients about tobacco and nicotine product cessation; 2) To connect nicotine and tobacco users willing to quit to an evidence-based cessation program; 3) To achieve 36.8% tobacco and nicotine product cessation rates among program participants among 1500 patient participants over the 3-year period.

Over three years, a minimum of 365 providers will be trained. The estimated number of patient tobacco users indirectly reached will be about 30,000. We believe this application is significant because there is an unfilled niche among rural populations and this program could help fill this gap.

This project can have a cascade of benefits: increasing productivity by individuals who quit using tobacco, reducing secondhand smoke exposure among nonsmokers, and result in lower rates of morbidity and mortality. The tobacco education training will strengthen clinician knowledge, practice, confidence, and fulfill training needs to advance practice patterns in the participating health clinics. Sustainability can be achieved through leveraging increased financial investments in nicotine and tobacco cessation interventions by lawmakers.

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