Need. Tobacco use is causally linked to ~17 different cancers and is responsible for 80-90% of lung cancer deaths. Low-dose computed tomography (LDCT) is the only recommended screening test for lung cancer. LDCT screening criteria have recently changed to expand the pool of eligible adults, which in part may help to address known disparities whereby Black Americans are less likely to be diagnosed early and, consequently, less likely to survive lung cancers relative to White Americans. This will create opportunities for contact with new and greater numbers of at-risk patients, many of whom may still be actively smoking cigarettes and/or at risk for smoking relapse. Unfortunately, research pub...

Read More

Need. Tobacco use is causally linked to ~17 different cancers and is responsible for 80-90% of lung cancer deaths. Low-dose computed tomography (LDCT) is the only recommended screening test for lung cancer. LDCT screening criteria have recently changed to expand the pool of eligible adults, which in part may help to address known disparities whereby Black Americans are less likely to be diagnosed early and, consequently, less likely to survive lung cancers relative to White Americans. This will create opportunities for contact with new and greater numbers of at-risk patients, many of whom may still be actively smoking cigarettes and/or at risk for smoking relapse. Unfortunately, research published in 2022 indicated that lung cancer screening centers (hereafter, LDCT) across Texas largely fail to furnish active, evidence-based smoking cessation interventions to patients, despite this being a best practice recommended by several prominent national groups (https://doi.org/10.1002/cncr.34145). In PP230002, we propose to disseminate and implement Taking Texas Tobacco Free (TTTF), a successful, evidence-based tobacco control intervention for cancer prevention that will provide policy and workflow guidance, specialized training, and resources to LDCT centers to bolster their ability to provide cessation and relapse prevention interventions to their patients. TTTF has evolved across 6 CPRIT funded awards in behavioral health care and community agency settings and is currently being implemented in medical settings (FQHCs), designed to address similar barriers as seen in LDCT centers. Responsiveness to CPRIT priorities include that it: 1) prioritizes populations disproportionately affected by cancer; 2) prioritizes underserved populations (e.g., via culturally-informed tobacco use care for Black Americans); 3) is an interdisciplinary project; 4) is a collaborative project between nonprofit entities; 5) is a project to eliminate tobacco use to reduce new cases and deaths from tobacco-related cancers; 6) increases screening and early detection among Texans at risk for lung cancer; and 7) develops or strengthens the infrastructure supporting the delivery of the most appropriate cancer prevention services. Overall Project Strategy. The previously implemented program, TTTF, will be fully scaled-out for application in LDCT centers. TTTF implementation in >/= 9 LDCT centers (# as time/budget allows) will include the: 1) initiation (or refreshing) of tobacco-free workplace policies; 2) provision of education and specialized training with a focus on how to facilitate culturally-informed tobacco use cessation and relapse prevention with patients via behavioral intervention and medicinal aids while enabling capacity for a sustainable center-led training program; 3) provision of resources to educate and motivate patients and providers for tobacco use disorder care provision; and 4) engagement and education of the community around these topics. A mixed methods evaluative process will guide program adaptation and implementation, with an emphasis on capacity building for sustainment beyond the project period. Active and passive dissemination strategies will include a step-by-step implementation/replication guide and toolkit with training materials, tailored materials for passive dissemination, web-based and social media program promotion, and hands-on technical assistance. TTTF implementation will include exploration through formative evaluation, organizational preparation, active program implementation, and sustainment/maintenance. Iterative stakeholder feedback will guide implementation. The project team has an extensive record of collaboration, is firmly grounded in implementation science and health equity interventions and has generated participation commitment from LDCT centers. Specific Goals. PP230002 has 3 primary goals: 1) adapt TTTF for dissemination and implementation in LDCT centers; 2) execute and evaluate an active implementation within >/=9 LDCT centers to fully inform the dissemination products (e.g., step-by-step implementation/replication guide) to reflect setting-specific considerations, barriers, and solutions; and 3) passively and actively disseminate the adapted TTTF program to LDCT centers across the state (providing technical assistance for center-led implementation), the community-at-large, and academic audiences. Significance and Impact. PP230002 will increase the capacity for, and the provision of, evidence-based practices for tobacco use disorder intervention in LDCT centers and thereby help to prevent lung and other tobacco-related cancers and improve survival rates (https://doi.org/10.1016/j.jtho.2021.12.005). Moreover, the dissemination materials and the technical assistance we provide will facilitate LDCT center-led adoption of the program across the state. Consequently, it will have a significant impact on tobacco-related cancer prevention among a highly vulnerable group of Texans.

Read Less