Transcript Nicotine Dependence Treatment for Hypertensive African

Promoting Tobacco Control and the
Puerto Rico Quitline through a
Community-Based Outreach Program
Carlos Mazas, Ph.D., Instructor
Department of Health Disparities Research
Funded by the National Cancer Institute
U54 CA096300-05
University of Puerto Rico and the M. D. Anderson Cancer Center
Partnership for Excellence in Cancer Research
Background
• Hispanics are the largest and fastest growing minority group in
the U.S. (14% of the U.S.)
• Tobacco use is a major public health problem among Hispanics
including Puerto Ricans living in Puerto Rico (PR)
 Smoking prevalence is lower among the population in Puerto
Rico than among the general population (12.7% vs. 20.9),
 Three of the four leading causes of death among Puerto
Ricans are related to smoking (heart disease, cancer, stroke)
 Lung cancer is the leading cause of cancer deaths among
Puerto Ricans
 More than 10% of all health care costs in PR are attributable
to smoking
 Thus, even though the prevalence rate of smoking is lower in PR
than the continental USA, tobacco still places a tremendous public
health burden on the people of PR
Tobacco-Related Disparities and Hispanics
Disparities in cessation affecting Hispanics relative to
non-Hispanics (National Health Interview Survey)
 Less motivated to quit (71 vs. 62%)
 Less likely to have made a quit attempt in the
preceding year (41 vs. 38%)
 Less likely to have successfully quit (former
smoker/eversmoker; 51 vs. 43%)
Health care delivery disparities affecting Hispanics
relative to non-Hispanics
 Highest rates of no health insurance of any
racial/ethnic group in the U.S. (33%)
 Less likely to visit a physician or to have a personal
health care provider
 Less likely to receive cessation advice from a
physician during a quit attempt
 Less likely to utilize pharmacotherapy during a quit
attempt
Intervention Development & Delivery Among Hispanics
Freeman,
2004
Hispanics experience disparities in the delivery of preventive health
care including tobacco cessation interventions.
There are exceedingly few randomized clinical trials (gold standard)
demonstrating intervention efficacy among Hispanic smokers.
Because of the dearth of interventions designed to help minorities and
underserved populations, the development and evaluation of such
interventions has been identified as a national health priority (Fiore et al.,
2000; USDHHS, 1998).
Specific Aims of the Outreach Program
 Increase the utilization of the Puerto Rico
Quitline.
 Provide career development opportunities in
cancer prevention to researchers and
community partners.
 Develop collaborations among the University
of Puerto Rico (UPR), M. D. Anderson Cancer
Center (MDACC), and key PR health and
community-based organizations interested in
tobacco control.
Puerto Rico Quitline (PRQ)
In 2004, the Puerto Rico Department of
Health implemented a telephone-based
smoking cessation program funded by the
Centers for Disease Control and Prevention
(CDC).
PR residents can call a toll free local
number (1-877-335-2567) or the National
Quitline number, 1-800-QUIT-NOW, and will
be automatically transferred to the local
number.
PRQ (continued)
Proactive service
~ 7 counseling calls over a period of one year
Mailed Quit-Kit – Quit guide, handheld stress
relievers, substitutes for smoking, etc.
Data collection
Outreach Program Methods
•
The Outreach Program began in April of 2005
•
Success and sustainability of the project was
measured by the following criteria:
1. Numbers of calls to the PRQ
2. Number of alliances supporting the PRQ
3. Number of presentations, trainings, manuscripts,
and grant proposals produced by the outreach
team with a focus on developing junior faculty and
increasing cancer research capacity in PR.
Results of the Outreach Program
ACTIVITIES IMPLEMENTED DURING THE PILOT PERIOD
EDUCATION – INTERVENTION
Conference to Promote Smoking Cessation and the Use of the PRQ
Development of the PRQ Logo
Development and Production of Smoking Cessation and Quitline
Promotional Materials
Development and Production of Materials for Health Care Professionals Kit
E-Newsletter
Educational Activities Promoting Tobacco Cessation
Passing the Indoor-Smoking Ban – Law 66
Creation and Maintenance of a Steering Committee to Oversee Outreach
Activities
Collaboration with Community-Based Organizations
TRAINING
PRQ Counselors Training
Health Care Providers Training and Technical Assistance on Best Practices
for Tobacco Cessation
RESEARCH
PRQ Call History and Demographics of Callers
2005
2006
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Conferences to Promote the PRQ
• Cumbre de Tabaquismo 2005 and 2006 were organized
by the outreach team
 CONFERENCES OBJECTIVES:
 Develop and implement an Outreach Agenda for Smoking
Cessation in Puerto Rico and generate an outreach action
plan for increasing the utilization of the PRQ among smokers
in PR.
 Build collaborations between the UPR, MDACC tobacco
outreach team, and key organizations such as the PR
Department of Health, PR Tobacco Control Coalition,
legislators, health care systems, health care providers, and
other organizations involved in tobacco control.
 Establish commitments of collaboration among the
participants through the education of each conference
participant in tobacco cessation and control practices.
2005 and 2006 Conference Results
 For the first time in PR, over 60 community-based
organizations representing private, religious, hospital,
health centers, health insurers, education, youth,
government and media sectors met and agreed to
actively support smoking cessation, tobacco control,
and the PRQ.
 Selected 11 Steering Committee members to coordinate
outreach activities and mediate community needs.
 Trained 132 physicians, dentists, and health care
administrators on integrating smoking cessation into
their practices.
 Implemented the Fax-to-Quit program among physicians
and dentists throughout the island based on the
principles of Ask, Advise, and Connect.
Development of Materials
Educational Activities
MEDIA CAMPAIGNS
 PSA ads and TV and radio interviews promoting the PRQ
 Promoting and supporting Law 66 – an indoor smoking ban
and the most aggressive smoking ban in the Caribbean
 Smoke-Out Day
ORAL PRESENTATIONS
 Cumbre de Tabaquismo 2005 and 2006
 PR College of Physicians and Dentists
 PR Oncology Association
 PR Churches, School District, and college campuses
POSTER PRESENTATIONS
 Cumbre de Tabaquismo 2006
 19 posters (11 from community partners)
Training
TRAINING
Trained 1 postdoctoral fellow and 3 junior faculty
from UPR and MDACC on cancer prevention
research, research designs, brief intervention,
manuscript writing, budget and grant preparation.
Trained counselors who provide smoking
intervention to the PRQ callers on smoking
cessation and motivational interviewing
Trained 26 community partners and Steering
Committee members on best practices in
smoking cessation and tobacco control
Academic Products
Manuscripts:
 Characteristics of smokers accessing the PRQ
 Integrating community, government, and academic institutions
to promote tobacco cessation: The Puerto Rico Quitline
Grant Submission:
 Oral Cancer Risk Reduction through Combined Treatment of
Tobacco and Alcohol Use
 Recently applied for the renewal of the Outreach Program:
Puerto Rico Community Cancer Control Outreach Program –
focusing on tobacco-related cancers, and breast and cervical
cancers
Oral Presentations
 National Latino Council on Alcohol and Tobacco Prevention
(LCAT)
Poster Presentation
 American Public Health Association (APHA) 133rd Annual
Meeting, Dec 10-14, Philadelphia, Pennsylvania.
 13th World Conference on Tobacco and Health. July 12-15, 2006.
Washington D.C
PRQ
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Male
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Summary
The Outreach Program was able to accomplish the
following objectives:
1. Held two major conferences to promote
tobacco control in PR
2. Developed an extensive network of over 60 PR
organizations
3. Gained the collaboration of key PR
government, health agencies, and leaders
4. Provided career development opportunities in
cancer prevention to junior faculty and
community partners
Summary (continued)
5. Secured funding from the PR government
and industry to further the aims of the
Outreach Program
6. Contributed to the passage of a strong
smokefree law for closed spaces
7. Developed a new and innovative research
project aimed at reducing the risk of
tobacco- and alcohol-related cancers.
8. Expanded the goals of the project to include
breast and cervical cancer screening
ACKNOWLEDGEMENTS
OP Research Collaborators
University of PR CC
UT M. D. Anderson CC
Elba C. Diaz-Toro, DMD
Maria C. Santos Ortiz, Ph.D.
Ana P. Ortiz, Ph.D.
Virmarie Correa-Fernandez, Ph.D.
William Calo, MPH
David W. Wetter, Ph.D.
Luz M. Mejia, MA