Addressing Tobacco Use in Underserved Communities Outside of Primary Care: The Need to Tailor Tobacco Cessation Training for Community Health Workers

Abstract

Individuals from communities with a low socioeconomic status have the highest rates of tobacco use but are less likely to receive assistance with quitting. Community health workers (CHWs) are well-positioned to engage these communities; however, CHWs face barriers in receiving relevant tobacco cessation training. The objective of this study was to conduct a mixed methods needs assessment to describe tobacco practices and the desire for training among CHWs. After incorporating CHW feedback, we developed a needs assessment survey to understand knowledge, practices, and attitudes about tobacco cessation in Chicago, IL. CHWs (N = 23) recruited from local community-based organizations completed the survey online or in-person. We then conducted a focus group with CHWs (N = 6) to expand upon the survey and used the Framework Method to analyze the qualitative data. CHWs reported that their clients had low incomes, low literacy levels, and high smoking rates (e.g., “99%” of patients). About 73.3% reported discussing tobacco use during visits, but fewer reported that they had provided cessation advice (43%) or intervened directly (9%). CHWs described high variability in their work environments (e.g., location, duration, content of visits, etc.) and greater continuity of care. CHWs discussed that existing training on how to conduct tobacco interventions is ineffective, because of its stand-alone design. Our findings illustrate how CHWs adapt to their clients’ needs, and that the currently available “gold-standard” cessation curricula are incompatible with the training needs and flexible care delivery model of CHWs. A curriculum tailored to the CHW experience is needed to maximize the strengths of the CHW care model by training CHWs to adaptively intervene regarding tobacco use in their highly burdened patients.

A Randomized Trial to Address Food Insecurity and Promote Smoking Cessation Among Low-Income Adults

“… 37 Given high rates of tobacco use in certain patient population groups, researchers have also highlighted the value of providing CHWs with tailored tobacco cessation training to maximize CHW-involved patient care. 38 As state Medicaid programs vary on coverage or reimbursement models for CHW services, the involvement of CHWs in smoking cessation studies may also have important health policy implications. However, we note that healthcare systems and clinics can highly vary in CHW availability and involvement.…”

The effects of a lung cancer awareness intervention in KwaZulu-Natal (KZN): a stratified cluster based study in five representative communities

“…Thus, an overwhelming majority of lung cancer patients are not diagnosed early, and treatment is initiated late. This reduces the effectiveness of treatment, which results in most lung cancer patients dying whilst on treatment (48)(49)(50)(51). Most patients with advanced cancer will die prematurely, and the length of survival (five and ten years) may vary considerably, affecting the quality of life if they enter remission.…”

“…However, the intervention was intended to raise awareness about lung cancer and encourage health-seeking behaviour among community members that experience lung cancerrelated symptoms. Tan and colleagues (48) suggest that CHWs also be trained on smoking cessation, a role that has been traditionally played by doctors during screening. This prospect should be explored in future studies in settings like South Africa.…”