Abstract 3677: Incorporating societal determinants of health with implementation science to increase tobacco cessation patient and community responsiveness
Authors: Ashing Kimlin T. , Yeung Sophia , Presant Cary A. , Macalintal Jonjon , Tiep Brian , Sandoval J , Gascon Brenda , Salgia R , Brown Susan J. , Rosen Steven 
Published: June 2022

Abstract
Background: Implementing tobacco cessation has been challenging across multi-racial and multi-ethnic regional communities. Multilayered influences of Societal Determinants of Health (SDH), social risks, environment, role of stress and perceived levels, tobacco addiction and behaviors are complex. Effective identification of social risk factors and unmet social needs of individuals can enhance tobacco treatment quality, and care coordination across the healthcare continuum. Integrating SDH and Implementation science into electronic health record (EHR) can provide both value and principles that promises to enhance patient and community responsiveness to address Catchment Area cancer burden and health disparities.
Methods: We included a 33 item SDH measure to our tobacco use assessment (TUA) instrument and applied implementation science with tobacco cessation program at City of Hope (COH). Our SDH assesses patients’ appraisal of their contextual distress including access to primary and cancer related medical care, technology and digital access and proficiency, food insecurity, career/job, income, education distress; housing, living situation and social network/isolation and racism and discrimination stress. The measure follows a 5pt likert scale ranging from extreme stress to no stress.
Results: This study compared 173 self-reported TUA. The mean age of first smoked a cigarette was 16 y.o. The mean age of first began smoking cigarettes regularly was 18 y.o. The mean total years of smoking was 36 years. Most participants were everyday smokers and on average, participants smoked I pack/day. &gt;50% of the patients lived in a place where other people smoked cigarettes indoors. 55% of the patients tried to quit in the past 30 days. 60% of the patients indicated that it is EXTREMELY important for them to quit smoking/tobacco and indicated interest in tobacco cessation. Half of the patients indicated they are NOT SO confident in their ability to quit smoking/tobacco. Below are the items commonly endorsed as extreme stressful: Health and cancer outcomes, using telehealth (e.g., using a smartphone or tablet for tele/virtual clinical visits, patient portal, completing online forms, virtual classes), money or finances, and functional strain (e.g., family demands).
Conclusions: SDH is complex and multilayered as well as understudied. The results support the small body of research documenting the necessity and utility of measuring and addressing SDH to correct health disparities. Increased prioritization including assessing and intervening with strategic planning and IT integration is required to better understand and address the cancer impact including tobacco cessation relevant to SDH. Successful tobacco control programs can benefit from IT integrated, culturally and community informed SDH assessments using implementation science principles.
Citation Format: Kimlin T. Ashing, Sophia Yeung, Cary A. Presant, Jonjon Macalintal, Brian Tiep, J Sandoval, Brenda Gascon, R Salgia, Susan J. Brown, Steven Rosen. Incorporating societal determinants of health with implementation science to increase tobacco cessation patient and community responsiveness [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3677.