246530 Short-term impact of a randomized, clinic-based trial to improve tobacco cessation services in free clinics

Tuesday, November 1, 2011

Kristie Long Foley, PhD , Medical Humanities Program, Davidson College, Davidson, NC
Eun-Young Song , Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
Kate Stewart , Biology, Davidson College, Davidson, NC
Donald Helme, PhD , College of Communications and Information studies, University of Kentucky, Lexington, KY
Jessica R. Pockey, MPH , Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
John Spangler, MD, MPH , Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NY
Erin L. Sutfin, PhD , Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
Cindy Jones, RCP , Ncafc, North Carolina Association of Free Clinics, Winston-Salem, NC
Background: Limited access to cessation programs among the uninsured who use tobacco may contribute to their excess disease burden and poorer survival. Methods: A pilot study to test the impact of evidence-based tobacco cessation strategies in 6 free clinics for the uninsured was undertaken. Six clinics were randomized to receive onsite education by a physician cessation expert or a training director of a free clinic advocacy organization. Systems-level and provider strategies were used to improve patient cessation and provider behavior. Repeated cross-sectional patient exit interviews assessed tobacco use (n=304), provider behavior regarding asking about tobacco (n=301) and, among users, advice and assistance with quitting (n=156) at baseline and 1-month after the intervention. Results: 73% of all patients were asked about tobacco use before and after the intervention. Patients were more likely to be advised to quit (61% vs. 76%, p=.05) and provided with quit assistance (33% to 61%, p<.001) after the intervention. In the multivariable model controlling for patient demographics, the odds of being advised to quit after intervention was not statistically significant (OR=1.68, 95%CI 0.84-3.38), while the odds of being assisted to quit was marginally significant (OR=2.74, 95%CI 0.96-7.85). The percentage of patients who use tobacco declined from 58% to 45%, p=.02 one month after the intervention. Trends are in the desired direction. Conclusions: This intervention appears to improve tobacco cessation and provider behavior related to advice and assistance with quitting, at least in the short-run. Follow-up to assess sustainability of the intervention is underway.

Learning Areas:
Social and behavioral sciences
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Demonstrate the value of a clinic-based intervention in free clinics to influence provider behavior and reduce tobacco use among the uninsured

Keywords: Underserved Populations, Tobacco

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the principal investigator of the research study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.