Abstract B21: Community health worker led smoking cessation intervention in Virginia Appalachia

Abstract

Introduction: Smoking in the United States has steadily declined over the past several years; however, rural Virginia Appalachian communities have a substantially higher than average smoking prevalence than the rest of the country. A major challenge in providing effective and sustainable cigarette-cessation services to Virginia Appalachia is the geographic and economic diversity of the region, combined with much of the population residing in poor, medically underserved rural areas. Previous research has suggested that community health workers (CHWs) may be valuable in regions with limited financial and medical resources by acting as a bridge between patients and providers when access is limited by distance, health care provider shortages, and cultural stigma. The purpose of this study was to assess the feasibility and success of using CHWs for smoking-cessation services in two Virginia Appalachian health care settings.

Methods: Study enrollees were recruited from two sites: a local-family-owned pharmacy and a Federally Qualified Health Center (FQHC) in the Appalachian region of Virginia. Inclusion criteria were daily adult smokers (18+) who were patients at the clinic or the community pharmacy, and self-identified as ready to quit in the next 30 days. Enrollees were defined as individuals for whom a consent form and baseline assessment were completed. Enrollees were subset into a participant group defined as enrollees who completed at least the first session of the eight-session intervention plan. We used an intention-to-treat framework in calculating enrollee and participant quit rates. The program was designed to have eight sessions, with scheduling at the discretion of the CHW and participant. Sessions five and eight were to be completed by the respective health care provider for the clinic and pharmacy. Sessions one and two were completed by the CHW in person with the participant, and sessions three, four, six, and seven were completed by the CHW over the phone. During the sessions, CHWs helped participants develop skills in identifying and addressing barriers to a successful cigarette quit, providing support in adhering to their quit plan, and discussing challenges and barriers they were facing in their quit attempt.

Results: Twenty-three individuals were enrolled in the study, with twenty distinguished as participants. The enrollee quit rate was 22%, with a participant quit rate of 25%. Overall, we found a statistically significant decrease in all participants' average cigarettes smoked per day over the eight sessions. Almost all participants failed to complete sessions 5 and 8 with their health care provider. All participants highly rated the program with 100% satisfaction on flexibility of scheduling, level of comfort, positivity, and helpfulness of the CHW.

Conclusion: The use of CHWs in Virginia Appalachian communities within our pilot study for cigarette cessation services appears promising. Challenges were noted in attendance to sessions five and eight in the clinic setting. This may speak to the difficulty of going back to their care provider due to challenges in scheduling, concerns about cost of visit, and transportation. The flexibility of working with CHWs, in their own community, over meeting with care providers may provide a benefit to the use of CHWs in future smoking-cessation programs. Future research should explore expanded integration of CHWs into comprehensive tobacco-cessation services in health care settings including the cost-benefit analysis and sustainability of the CHW model.

Citation Format: Lindsay Hauser, Catherine Labgold, Roger Anderson, Fabian Camacho. Community health worker led smoking cessation intervention in Virginia Appalachia [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B21.