Abstract A091: Beliefs and behaviors regarding non-cigarette tobacco use cessation care differ between providers at substance use treatment centers and community health centers serving rural and/or medically underserved areas of Texas
Authors: Carter Brian J. , Britton Maggie , Chen Tzuan A. , Leal Isabel Martinez , Siddiqi Ammar D. , Williams Teresa , Casey Kathleen , Sanchez Hector , Kakarla Sriya , Reitzel Lorraine R. 
Published: September 2024

Purpose: Cancer mortality rates are higher in rural versus urban areas of the US, partly due to elevated tobacco use (including non-cigarette tobacco products (NCTPs); e.g., dip, snuff, vapes). Clinical practice guidelines call for tobacco use screening and brief intervention at every patient contact. Limited literature examines actual practices with respect to NCTP use in healthcare centers in rural and/or medically underserved areas (MUAs). This study examines if providers at substance use treatment centers (SUTCs) and community health centers (CHCs; e.g., Federally Qualified Health Centers) in such areas of Texas view NCTP cessation counseling as an important part of their job and if they use the 5As (Ask, Advise, Assess, Assist, Arrange) and motivational interventions to address their patients’ NCTP use. Methods: Providers from 21 healthcare centers (12 SUTCs, 9 CHCs) that had been solicited to later receive resources to improve their tobacco cessation care responded to face-valid survey items about their tobacco use screening and intervention delivery over the last month, along with their view on whether NCTP cessation counseling is an important part of their job. In total, 347 providers from SUTCs (n=174) and CHCs (n=173) serving 126 of Texas’ 254 counties responded. Linear mixed models and generalized linear mixed models were used to assess the differences between SUTCs and CHCs for continuous and binary variables, respectively. Results: Only 52% of providers agreed that NCTP cessation counseling is an important part of their job, with a significantly greater percentage (p=0.0023) agreeing at CHCs (63%) than at SUTCs (40%). Providers Asked 62% of their patients whether they used NCTPs. Of patients who endorsed use (20%), providers Advised 58% to quit and Assessed 53% about their interest in quitting. However, providers only Assisted 34% of use-endorsing patients in making a quit attempt and only Arranged follow-up for 23% of them. A significantly greater percentage (p=0.0025) of those patients were Advised to quit at CHCs (72%) than at SUTCs (44%). Providers delivered brief motivational interventions to 74% of patients who were not ready to quit, with significantly greater percentages advising patients to consider quitting in the future (p=0.0365) and telling patients they would revisit the topic at the next visit (p=0.0264) at CHCs (63% and 37%, respectively) than at SUTCs (45% and 24%, respectively). However, providers encouraged only 39% of use-endorsing patients to stop NCTP use completely, with a significantly greater percentage (p=0.0010) doing so at CHCs (50%) than at SUTCs (28%). Conclusion: Providers surveyed at healthcare centers in rural and/or MUAs of Texas were more likely to deliver evidence-based NCTP cessation care at CHCs than at SUTCs. Patients at both CHCs and SUTCs would benefit from their providers placing greater value on NCTP cessation care and more consistently delivering such care per guidelines. These data will inform healthcare centers’ implementation of best practices in treating their patients’ NCTP use.

Citation Format: Brian J. Carter, Maggie Britton, Tzuan A. Chen, Isabel Martinez Leal, Ammar D. Siddiqi, Teresa Williams, Kathleen Casey, Hector Sanchez, Sriya Kakarla, Lorraine R. Reitzel. Beliefs and behaviors regarding non-cigarette tobacco use cessation care differ between providers at substance use treatment centers and community health centers serving rural and/or medically underserved areas of Texas [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A091.