Smoking is the leading cause of preventable morbidity and mortality in the U.S. and has been linked to cancers of the lung, oropharynx, larynx, esophagus, stomach, pancreas, bladder, kidney and cervix. Although the health benefits of quitting are substantial, quit rates are low, and smokers with lower socioeconomic status tend to be less successful at quitting. Therefore, connecting underserved smokers with efficacious cessation treatment is crucial for disease prevention and the elimination of health disparities.

Unfortunately, existing evidence-based treatments have been grossly underutilized. Thus, the focus of this project is on increasing dissemination and enhancing utilization of an ex...

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Smoking is the leading cause of preventable morbidity and mortality in the U.S. and has been linked to cancers of the lung, oropharynx, larynx, esophagus, stomach, pancreas, bladder, kidney and cervix. Although the health benefits of quitting are substantial, quit rates are low, and smokers with lower socioeconomic status tend to be less successful at quitting. Therefore, connecting underserved smokers with efficacious cessation treatment is crucial for disease prevention and the elimination of health disparities.

Unfortunately, existing evidence-based treatments have been grossly underutilized. Thus, the focus of this project is on increasing dissemination and enhancing utilization of an existing evidence-based smoking cessation resource, the Texas Quitline. Despite the extreme burden that smoking places on the healthcare system and the tremendous potential of quitlines to increase the utilization of treatment, cessation treatment has not been well integrated or institutionalized within the healthcare system. Clinical providers have indicated that time and competing demands are critical barriers to delivering cessation assistance, and even when referred, patients seldom follow up to contact quitlines on their own.

Thus, increasing dissemination of the Quitline among underserved smokers will require that barriers at both the clinic and patient levels be addressed. By streamlining the burden of linking patients with treatment through the use of an automated system and providing patient contact information directly to the Quitline, the Ask-Advise-Connect approach will overcome two levels of existing barriers to dissemination in the primary care setting.

Licensed Vocational Nurses (LVNs) at the Good Neighbor Healthcare Center will be trained to implement an Ask-Advise-Connect approach to linking smokers with the Quitline. LVNs will be trained to ask all patients about their smoking status at every visit, briefly advise all smokers to quit, and offer to “connect” patients who agree to accept assistance with the Quitline through an automated link in the electronic medical record (EMR). Good Neighbor serves almost exclusively low-socioeconomic status and racial/ethnic minority individuals in Houston. The project is a close partnership and collaboration between Good Neighbor, the Quitline, and MD Anderson Cancer Center.

If successful, the program could easily and seamlessly be adopted by other organizations throughout Texas and be used to link tens of thousands of smokers with evidence-based treatment. Even modest increases in the reach and effectiveness of existing evidence-based treatment programs could dramatically reduce smoking prevalence in Texas. Furthermore, enhancing the dissemination and implementation of existing “best practices” for tobacco cessation would likely have an even stronger impact through reaching smokers with the least motivation to quit, highest smoking rates, and most profound smoking-related health disparities.

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