Abstract A095: Differences in providers’ perceived preparedness and actual delivery of screening and intervention practices for patients who smoke cigarettes between two types of healthcare centers serving rural and/or medically underserved areas of Texas
Authors: Siddiqi Ammar D. , Britton Maggie , Chen Tzuan A. , Leal Isabel Martinez , Carter Brian J. , Williams Teresa , Casey Kathleen , Skeene Kim , Sanchez Hector , Kakarla Sriya , Reitzel Lorraine R. 
Published: September 2024

Abstract
Introduction: Rural populations in the US bear a disproportionate burden of cancer mortality. This is partly due to their elevated tobacco use rates. Best practice guidelines promote tobacco use screening and brief intervention at every patient contact; however, limited literature evaluates compliance in healthcare centers in rural and/or medically underserved areas (MUAs). Here, we examine providers’ use of the 5As (Ask, Advise, Assess, Assist, Arrange) and motivational interventions (for those not ready to quit; e.g., 5Rs: Relevance, Risks, Rewards, Roadblocks, Repetition) with their patients in substance use treatment centers (SUTCs) and medical healthcare centers (MHCs; e.g., Federally Qualified Health Centers) located in rural and/or MUAs in Texas to identify screening and intervention gaps. Methods: Providers from participating healthcare centers (12 SUTCs, 9 MHCs) responded to a solicitation assessing interest in (later) receiving tobacco use intervention training and resources. In total, 347 providers from SUTCs (n=174) and MHCs (n=173) serving 126 counties responded to an anonymized survey about their smoking screening and intervention delivery over the last month, along with their rating of how prepared they thought their healthcare center’s provider workforce was to help patients stop using tobacco (completely or somewhat prepared vs neutral, somewhat unprepared, or not at all prepared). Linear mixed models and generalized linear mixed models were used to assess the differences between SUTCs and MHCs for continuous and binary variables, respectively. Results: Overall, providers Asked 68.31% of their last-month patients whether they smoked cigarettes. Of patients who endorsed smoking (23.94%), providers Advised 58.68% to quit and Assessed 51.90% about their interest in quitting. However, providers only Assisted 35.87% of patients who endorsed smoking in making a quit attempt and 22.79% in Arranging a follow-up. A significantly greater percentage of patients were Asked (p=.0226) and Advised (p=.0025) to quit at MHCs (Ask=77.21%, Advise=72.35%) than at SUTCs (Ask=59.57%, Advise=45.34%). Providers delivered brief motivational interventions to 70.16% of patients who were not ready to quit smoking, with no significant differences between SUTCs and MHCs. Finally, 56.07% of providers at MHCs reported their workforce was prepared to help their patients quit tobacco, significantly greater than the 40.80% reported at SUTCs (p=.0268). Conclusion: Patients at MHCs were more likely to receive comprehensive tobacco cessation care than those at SUTCs in this sample of healthcare centers serving rural and/or MUAs in Texas. However, providers at both types of healthcare centers would benefit from greater workforce preparation to enable the provision of consistent tobacco use screening and brief intervention delivery in line with best practice guidelines. Future work will use these data for intervention and implementation strategy planning to improve centers’ capacity to comprehensively address their patients’ tobacco use.
Citation Format: Ammar D. Siddiqi, Maggie Britton, Tzuan A. Chen, Isabel Martinez Leal, Brian J. Carter, Teresa Williams, Kathleen Casey, Kim Skeene, Hector Sanchez, Sriya Kakarla, Lorraine R. Reitzel. Differences in providers’ perceived preparedness and actual delivery of screening and intervention practices for patients who smoke cigarettes between two types of healthcare 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 A095.