Promoting Tobacco Control and the Puerto Rico Quitline through a Community-Based Outreach Program

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Promoting Tobacco Control and the Puerto Rico
Quitline through a Community-Based Outreach
Program

• Carlos Mazas, Ph.D., InstructorDepartment of
  Health Disparities ResearchFunded 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

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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

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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

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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).

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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.

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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.

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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

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Outreach Program Methods

• The Outreach Program began in April of 2005
• Success and sustainability of the project was
  measured by the following criteria
• Numbers of calls to the PRQ
• 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.

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Results of the Outreach Program
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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.

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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.

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Development of Materials
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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)

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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

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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

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PRQ
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Summary

• The Outreach Program was able to accomplish the
  following objectives
• Held two major conferences to promote tobacco
  control in PR
• Developed an extensive network of over 60 PR
  organizations
• Gained the collaboration of key PR government,
  health agencies, and leaders
• Provided career development opportunities in
  cancer prevention to junior faculty and
  community partners

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Summary (continued)

1. Secured funding from the PR government and
   industry to further the aims of the Outreach
   Program
2. Contributed to the passage of a strong smokefree
   law for closed spaces
3. Developed a new and innovative research project
   aimed at reducing the risk of tobacco- and
   alcohol-related cancers.
4. Expanded the goals of the project to include
   breast and cervical cancer screening

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ACKNOWLEDGEMENTSOP Research Collaborators

• University of PR 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

• UT M. D. Anderson CC
• David W. Wetter, Ph.D.
• Luz M. Mejia, MA