Research aims to expand smoking cessation in underserved populations

Researchers at the University of Illinois Chicago have received more than $3.3 million to study the burden of tobacco use and to improve smoking cessation interventions for populations with demonstrated high smoking rates. 

The study aims to show the feasibility, success, and cost-effectiveness of electronically delivered smoking cessation interventions via patient portals in a network of federally qualified health centers, or FQHCs, called Mile Square Health Center. The project, Mi Quit CARE — for Mile Square Quit Community Access Referral Expansion — is funded by the National Heart, Lung, and Blood Institute.

Phoenix Matthews, UIC professor of population health nursing science and associate dean for equity and inclusion at the College of Nursing, and their team will evaluate knowledge, attitudes, barriers, and facilitators to smoking cessation. They also will further develop community engagement strategies to increase patient use of online health portals such as MyChart. 

In addition, they will test the ability to expand the delivery of Mi Quit CARE, which is a free program that helps Mile Square patients who want to reduce the amount they smoke or kick the habit for good using free resources provided by the Illinois Tobacco Quitline. The program has been in place for five years at Mile Square clinics. 

Low-income populations are disproportionately burdened by tobacco use and carry a greater burden of pulmonary health inequalities related to smoking. One aim of the project is to develop a strategy to involve FQHC providers that serve disadvantaged populations to deliver smoking cessation information and programs. Researchers will also include community stakeholders, asking for their guidance on developing strategies tailored to the community.  

“We’ll be involving community stakeholders throughout the project including convening an advisory board and conducting focus groups and individual interviews. Community stakeholder involvement will help to ensure that we are addressing the needs of the Mile Square community,” Matthews said.

Karriem Watson, clinical assistant professor of community health sciences and associate director of health equity and community engagement for the University of Illinois Cancer Center, stressed the importance of community involvement to build a culturally tailored plan. 

“Federally qualified care isn’t typically developed with input from community stakeholders. With this project, we get to play a clear role in developing health interventions,” Watson said.  

Patient use of portals like MyChart is low among Mile Square parents with approximately less than 5% enrolling and using MyChart, Matthews said. The project aims to increase MyChart use overall and to make educational materials more accessible to low-health literacy patients.  

Patient navigators, professionals trained in public health management, working in clinics will identify patients who have appointments with providers that day who also have tobacco use in their charts. Navigators will then meet with patients prior to their appointment to assess their readiness to quit smoking. Navigators will then follow up with the patient’s health provider to discuss smoking cessation plans.  

Watson explained how the patient navigator system, along with MyChart, works: A patient logs in to view their electronic chart and sees educational materials about smoking cessation services. They will also receive a message from their provider advising them to make a quit attempt and to let the patient know they will receive a call from the state tobacco Quitline. If the Quitline counselor is not able to reach the patient, then a patient navigator will contact the patient to conduct a motivational interview. In that discussion, the navigator can discover their readiness to quit or reduce their tobacco use. If they are ready, they can be referred back to the Quitline, or get a referral to a provider for smoking cessation medication. The patient may also receive information through their MyChart about cancer screenings. 

Matthews said the Mi Quit CARE expansion program has an aggressive goal to get 40% of patients who use tobacco to quit annually. Currently, 10% quit with the assistance of health care providers and 20% by using the Quitline. 

Another aspect of the research project will involve analyzing robust data sets to learn more about the tobacco burden and its influence on pulmonary health disparities such as lung cancer, COPD and asthma.  

Researchers hope to develop the program’s success and make it a system-wide template for other communities across the U.S., Matthews said.  

“Smoking rates are extremely high in low income and minority communities because of target-marketing of tobacco to racial/ethnic minority groups, high density of tobacco retailers in these neighborhoods, poor access to smoking cessation treatments, high rates of stress in low-income populations, and structural oppression,” Matthews said. “Given these risk factors, innovative strategies are needed to provide cost-effective treatments to those at greatest risk for smoking-related morbidities and mortality.”

Along with Matthews and Watson, Dr. Robert Winn from Virginia Commonwealth University is also a principal investigator of the award. The team also includes Dr. Nicole Gastala, Ashley Hughes, Alana Steffen, Carl Asche, Geri Donenberg, Sandeep Kataria, Dr. Ashish Ansal and Jack Neuner, all of UIC.