Promoting Tobacco Control and the Puerto Rico Quitline through a

Community-Based Outreach Program

Carlos Mazas, Ph.D., InstructorDepartment of Health Disparities Research

Funded by the National Cancer Institute

U54 CA096300-05

University of Puerto Rico and the M. D. Anderson Cancer Center

Partnership for Excellence in Cancer Research

Background

• Hispanics are the largest and fastest growing minority group in the U.S. (14% of the U.S.)

• Tobacco use is a major public health problem among Hispanics including Puerto Ricans living in Puerto Rico (PR) Smoking prevalence is lower among the population in Puerto Rico

than among the general population (12.7% vs. 20.9), Three of the four leading causes of death among Puerto Ricans

are related to smoking (heart disease, cancer, stroke)Lung cancer is the leading cause of cancer deaths among Puerto

Ricans More than 10% of all health care costs in PR are attributable to

smoking Thus, even though the prevalence rate of smoking is lower in PR than the

continental USA, tobacco still places a tremendous public health burden on the people of PR

Tobacco-Related Disparities and Hispanics

Disparities in cessation affecting Hispanics relative to non-Hispanics (National Health Interview Survey)Less motivated to quit (71 vs. 62%)Less likely to have made a quit attempt in the preceding year

(41 vs. 38%)Less likely to have successfully quit (former

smoker/eversmoker; 51 vs. 43%)

Health care delivery disparities affecting Hispanics relative to non-HispanicsHighest rates of no health insurance of any racial/ethnic

group in the U.S. (33%)Less likely to visit a physician or to have a personal health

care providerLess likely to receive cessation advice from a physician

during a quit attempt Less likely to utilize pharmacotherapy during a quit attempt

Freeman, 2004

Hispanics experience disparities in the delivery of preventive health care including tobacco cessation interventions.

There are exceedingly few randomized clinical trials (gold standard) demonstrating intervention efficacy among Hispanic smokers.

Because of the dearth of interventions designed to help minorities and underserved populations, the development and evaluation of such interventions has been identified as a national health priority (Fiore et al., 2000; USDHHS, 1998).

Intervention Development & Delivery Among Hispanics

Specific Aims of the Outreach Program

Increase the utilization of the Puerto Rico Quitline.

Provide career development opportunities in cancer prevention to researchers and community partners.

Develop collaborations among the University of Puerto Rico (UPR), M. D. Anderson Cancer Center (MDACC), and key PR health and community-based organizations interested in tobacco control.

Puerto Rico Quitline (PRQ)

In 2004, the Puerto Rico Department of Health implemented a telephone-based smoking cessation program funded by the Centers for Disease Control and Prevention (CDC).

PR residents can call a toll free local number (1-877-335-2567) or the National Quitline number, 1-800-QUIT-NOW, and will be automatically transferred to the local number.

PRQ (continued)

Proactive service

~ 7 counseling calls over a period of one year

Mailed Quit-Kit – Quit guide, handheld stress relievers, substitutes for smoking, etc.

Data collection

Outreach Program Methods

• The Outreach Program began in April of 2005

• Success and sustainability of the project was measured by the following criteria:

1. Numbers of calls to the PRQ

2. Number of alliances supporting the PRQ

3. Number of presentations, trainings, manuscripts, and grant proposals produced by the outreach team with a focus on developing junior faculty and increasing cancer research capacity in PR.

Results of the Outreach Program

ACTIVITIES IMPLEMENTED DURING THE PILOT PERIOD 2005 2006 EDUCATION – INTERVENTION Conference to Promote Smoking Cessation and the Use of the PRQ X X Development of the PRQ Logo X Development and Production of Smoking Cessation and Quitline Promotional Materials

X X

Development and Production of Materials for Health Care Professionals Kit X E-Newsletter X X Educational Activities Promoting Tobacco Cessation X X Passing the Indoor-Smoking Ban – Law 66 X Creation and Maintenance of a Steering Committee to Oversee Outreach Activities

X X

Collaboration with Community-Based Organizations X X TRAINING PRQ Counselors Training X

Health Care Providers Training and Technical Assistance on Best Practices for Tobacco Cessation

X

RESEARCH

PRQ Call History and Demographics of Callers X X

• Cumbre de Tabaquismo 2005 and 2006 were organized by the outreach team CONFERENCES OBJECTIVES:

Develop and implement an Outreach Agenda for Smoking Cessation in Puerto Rico and generate an outreach action plan for increasing the utilization of the PRQ among smokers in PR.

Build collaborations between the UPR, MDACC tobacco outreach team, and key organizations such as the PR Department of Health, PR Tobacco Control Coalition, legislators, health care systems, health care providers, and other organizations involved in tobacco control.

Establish commitments of collaboration among the participants through the education of each conference participant in tobacco cessation and control practices.

Conferences to Promote the PRQ

For the first time in PR, over 60 community-based organizations representing private, religious, hospital, health centers, health insurers, education, youth, government and media sectors met and agreed to actively support smoking cessation, tobacco control, and the PRQ.

Selected 11 Steering Committee members to coordinate outreach activities and mediate community needs.

Trained 132 physicians, dentists, and health care administrators on integrating smoking cessation into their practices.

Implemented the Fax-to-Quit program among physicians and dentists throughout the island based on the principles of Ask, Advise, and Connect.

2005 and 2006 Conference Results

Development of Materials

MEDIA CAMPAIGNS PSA ads and TV and radio interviews promoting the PRQPromoting and supporting Law 66 – an indoor smoking ban

and the most aggressive smoking ban in the CaribbeanSmoke-Out Day

ORAL PRESENTATIONSCumbre de Tabaquismo 2005 and 2006PR College of Physicians and DentistsPR Oncology Association PR Churches, School District, and college campuses

POSTER PRESENTATIONSCumbre de Tabaquismo 2006

19 posters (11 from community partners)

Educational Activities

TRAININGTrained 1 postdoctoral fellow and 3 junior faculty

from UPR and MDACC on cancer prevention research, research designs, brief intervention, manuscript writing, budget and grant preparation.

Trained counselors who provide smoking intervention to the PRQ callers on smoking cessation and motivational interviewing

Trained 26 community partners and Steering Committee members on best practices in smoking cessation and tobacco control

Training

Manuscripts:Characteristics of smokers accessing the PRQ Integrating community, government, and academic institutions to

promote tobacco cessation: The Puerto Rico Quitline Grant Submission:Oral Cancer Risk Reduction through Combined Treatment of Tobacco

and Alcohol UseRecently applied for the renewal of the Outreach Program: Puerto Rico

Community Cancer Control Outreach Program – focusing on tobacco-related cancers, and breast and cervical cancers

Oral Presentations National Latino Council on Alcohol and Tobacco Prevention (LCAT)

Poster PresentationAmerican Public Health Association (APHA) 133rd Annual Meeting, Dec

10-14, Philadelphia, Pennsylvania. 13th World Conference on Tobacco and Health. July 12-15, 2006.

Washington D.C

Academic Products

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Summary

The Outreach Program was able to accomplish the following objectives:

1. Held two major conferences to promote tobacco control in PR

2. Developed an extensive network of over 60 PR organizations

3. Gained the collaboration of key PR government, health agencies, and leaders

4. Provided career development opportunities in cancer prevention to junior faculty and community partners

Summary (continued)

5. Secured funding from the PR government and industry to further the aims of the Outreach Program

6. Contributed to the passage of a strong smokefree law for closed spaces

7. Developed a new and innovative research project aimed at reducing the risk of tobacco- and alcohol-related cancers.

8. Expanded the goals of the project to include breast and cervical cancer screening

ACKNOWLEDGEMENTSOP Research Collaborators

University of PR CCElba C. Diaz-Toro, DMD

Maria C. Santos Ortiz, Ph.D.

Ana P. Ortiz, Ph.D.

Virmarie Correa-Fernandez, Ph.D.

William Calo, MPH

UT M. D. Anderson CCDavid W. Wetter, Ph.D.

Luz M. Mejia, MA