Reducing tobacco use among special populations: Workplace tobacco control interventions in health and human service agencies

Background: Marked disparities in smoking rates persist among disenfranchised populations and underserved minorities, with L.A. County's highest rates among substance users (e.g., 59.8% for methamphetamine, cocaine or ecstasy users); heavy drinkers (28.4%); those with mental health conditions (e.g., 28.3% for anxiety, 22.1% for depression); the gay, lesbian, bisexual population (20.6%); and African American males (19.5%). To address these disparities, the Los Angeles County Department of Public Health implemented the Los Angeles County Pioneers in Tobacco Control Cessation Project (L.A. Pioneers), which funded and supported local health and human service agencies who commit to working towards a 100% tobacco-free policy and integrating other tobacco cessation interventions during a 6-month period from March 2011 – March 2012.

Methods: We performed an assessment of the overall implementation process to examine factors that may improve future planning or replication in other jurisdictions. Gathering triangulated information from semi-structured interviews (n=10) and programmatic data regularly collected during program facilitation, we provide a snapshot of one agency's experience spearheading an innovative program using Communities Putting Prevent to Work grant funds.

Results/Conclusion: A total of 60 agency sites participated, with an estimated annual primary reach of approximately 76,000 clients monthly and 5,500 staff. Though L.A. Pioneers succeeded in reaching priority populations, fiduciary challenges contributed to delays in each stage of L.A. Pioneers. Future efforts can be helped by integration of a pre-defined period for planning which incorporates an interdisciplinary leadership team and is reinforced by a payment scheme that paces the financial needs of the awardee.