Abstract A020: Connection to Health for Smokers: A comprehensive smoking cessation program for community health centers
Authors: Potter Michael B , Bowyer Vicky , Tsoh Janice Y , Parra Jose , Hessler Danielle 
Published: September 2020

Abstract
Background: California’s 1200 community health centers (CHCs) provide primary care to 1 in 7 Californians, a disproportionate number of whom are tobacco smokers, low income, and medically vulnerable due to adverse social environments, other adverse health-related behaviors, and co-occurring health conditions. Thus, CHCs are an important setting for interventions to address tobacco-smoking disparities, despite their often-limited resources to do so. The goal of this research is to develop, implement, and evaluate the feasibility and acceptability of Connection to Health for Smokers (CTHS), a new theory- and evidence-based program supported by online tools, for use by CHC-based health educators to systematically engage CHC patients to quit smoking. Methods: We developed CTHS using a participatory approach in collaboration with smoking cessation experts, behavioral scientists, CHC primary care providers and health workers, and pilot tested the intervention with patients at three sites in Contra Costa County. Results: CTHS incorporates a novel theoretical framework that includes 1) the 5A’s (ask, advise, assess, assist, and arrange); 2) evidence-based principles of priority setting and action-planning; 3) direct support to patients for implementing tailored strategies to prepare for quitting and to prevent relapse; 4) indirect support for smoking cessation by managing other social and behavioral barriers (e.g., depression, housing instability or homelessness, substance use) either before or during the smoking cessation process, and (5) provide a structure and prompts for arranged follow-up and automated support between appointments. CTHS conducts an online patient assessment, guides health educators and patients to collaboratively develop a tailored action plan, and delivers automated text reminders to assist patients with action plan implementation. The program design accounts for CHC clinic flow, allowing enrollment through primary care referrals or outreach using clinic-based smoker registries. To date, CTHS has been implemented in three clinical sites by 10 health educators working with 44 smokers, aged 21 to 68 years, of whom 43% self-identified, 43% self-identified as male, and 82% reported being daily smokers. Using CTHS, 32 (73%) patients developed action plans to quit smoking, 10 (23%) developed plans to cut down, and 2 (4%) chose to work on other health issues in preparation for quitting smoking in the future. Conclusion: CTHS is a novel smoking cessation program for patients served by CHCs that is feasible and acceptable to clinic teams and their patients who smoke. Further evaluation of program efficacy through a randomized clinical trial is both warranted and ongoing. Trial registration: NCT03680599.
Citation Format: Michael B Potter, Vicky Bowyer, Janice Y Tsoh, Jose Parra, Danielle Hessler. Connection to Health for Smokers: A comprehensive smoking cessation program for community health centers [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A020.