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. Furthermore, smokers with lower socioeconomic status tend to be less successful at quitting. Therefore, connecting underserved smokers with evidence-based cessation treatment is crucial for disease prevention and the elimination of tobacco-related cancer health disparities.

Unfortunately, existing evidence-based treatments for smoking cessation have been grossly underutilized. Thus, the focus of this program is on en...

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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. Furthermore, smokers with lower socioeconomic status tend to be less successful at quitting. Therefore, connecting underserved smokers with evidence-based cessation treatment is crucial for disease prevention and the elimination of tobacco-related cancer health disparities.

Unfortunately, existing evidence-based treatments for smoking cessation have been grossly underutilized. Thus, the focus of this program is on enhancing utilization of an existing evidence-based smoking cessation resource among low-SES and racial/ethnic minority smokers, the Texas Quitline. Specifically, we will implement an Ask Advise Connect (AAC) approach to deliver evidence-based smoking cessation treatment to all patients seeking care within the extensive HCHD community health clinic system. AAC utilizes the electronic medical record (EMR) to systematically prompt clinicians to assess the smoking status of every patient at every visit, advise him/her to quit smoking, and directly and electronically link interested smokers with the Quitline.

In a large study being conducted by our team at 10 of the HCHD community health clinics and over 110,000 patients to date, Quitline treatment uptake is 0.3% of all smokers in AAR clinics, vs. a Quitline treatment uptake of 12.8% among AAC clinics, a 42-fold increase. To the best of our knowledge, this is the highest population level cessation treatment uptake reported to date.

LVNs will be trained to ask all patients about their smoking status, advise all patients who smoke to quit, and connect patients who agree to accept cessation assistance with the Quitline through an automated link in the EMR. LVNs will receive initial training at the beginning of the program, and booster training sessions at several time points throughout the program. HCHD health educators housed within each clinic will serve as champions for the program.

The proposed prevention program builds upon a strong and established partnership between the Harris County Hospital District (HCHD), The Texas Quitline, Alere Wellbeing, and MD Anderson Cancer Center, and all partners will play substantial and integral roles in the project. The overarching goal of the program is to deliver evidence-based smoking cessation treatment to smokers seeking care within a large, safety net public healthcare system in Harris County, Texas, and ultimately reduce tobacco-related cancer morbidity and mortality, particularly among individuals who are disproportionately burdened with the disease. Furthermore, given recent policy initiatives associated with healthcare reform, AAC could ultimately be sustained through securing federal funds related to the demonstration of meeting meaningful use criteria for tobacco.

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