Case Management for Reaching and Treating Under-served Latino Smokers
This project focuses on enhancing Latino smoking cessation for patients seen in safety-net clinics, specifically determining the feasibility of using a case management approach to improve utilization of smoking cessation resources.
Funded by: National Cancer Institute – 1 K01 CA 136993-01 A1
Principal Investigator: Ana Paula Cupertino, Ph.D.
Co-mentors: Kimber Richter, Lisa Cox, Edward Ellerbeck and Won Choi
Study Personnel: Melinda Krautmann – Case Management, Mercedes Saint-Elin, Research Associate and Miriam Muñoz, Research Assistant
Cigarette smoking remains a serious public health concern and causes one-third of cancer-related deaths among U.S. Latinos. Pharmacotherapy and behavioral counseling can dramatically increase rates of smoking cessation, but Latinos are less likely than other ethnic groups to receive these interventions. An intervention that enhances utilization of smoking cessation resources and ultimately cessation has potential for substantial public health impact, especially if it is integrated into community safety net clinics.
Study 1 Specific Aim
To identify what nicotine dependence services are offered and how they are delivered in safety net clinics.
This was a qualitative study, conducted using interviews among providers and clinic staff and focus groups with Latino smokers and their families.
- Migration process and the meaning of being Latino in the United States
- Perceived Pros and Cons effect of Smoking
- Attitudes toward quitting
- Attitudes toward using medication and counseling
- Counselor’s culture/ethnicity and expectations regarding counselor
We also conducted a clinic environmental assessment and constructed a patient flow diagram summarizing how tobacco services are delivered in safety net clinics. This information was used to refine Study 2 procedures.
- How does clinic treat tobacco dependence
- Office system to ensure implementation
- Leadership for treating tobacco dependence
- Developing a smoking cessation treatment program
- Case Management
In Study 1 we have determined the best screening procedures for identifying smokers and smoking family members. We also refined the critical features of our case management. Critical information regarding the strengths and limitations of the intervention were explored in semi-structured interviews with participants at the end of the intervention.
Study 2 Specific Aim
To test the impact of smoking cessation case management on utilization of smoking cessation resources among Latino patients and family members that smoke.
Smokers receiving CM will be more likely than smokers in the control group to utilize smoking cessation pharmacotherapy and counseling.
A greater proportion of smokers receiving CM will be tobacco abstinent at six months, as measured by self-reported seven-day, point prevalence abstinence and biochemically verified abstinence.
We compared two community-based recruitment strategies: active on-site recruitment at a large community health fair and a reactive opt-out approach within three community-based databases. The opt-out recruitment consisted of two steps: opt-out letters were mailed to Latino smokers identified in the databases, and research staff contacted smokers one week after by phone to recruit participants, complete consent form, eligibility and baseline survey. Latino smokers identified at health fair completed consent form, eligibility and baseline survey on-site.
At on-site health fair recruitment, we identified, consented, and enrolled 14 Latino smokers; 100% participation rate. Using multiple databases, we mailed opt-out letter to 273 Latino smokers. After one week, we began calling participants: 120 (43.5%) had a wrong number or disconnected phones, 61 (22%) were never reached, 35 (13%) were no longer smokers. Out of 273 smokers, we reached 57 (21%) smokers by phone; 19 (33%) did not want to participate. Of smokers identified and reached, 67% consented to study participation and enrolled (52% female; 48% recent immigrants; 69% born in Mexico). Highest participation rate were identified 1st) using on-site recruitment at a binational health fair, 2nd) working with a database from a community-based cancer coalition and 3rd) promotora de salud recruitment within broad outreach activities.
Latino smokers are interested in participating in smoking cessation research intervention research. While on-site recruitment yielded higher participation rates and were conducted in one day, opt-out approach using community-based database should also be considered as feasible for screening a large number of ethnic minority smokers. Clinical researchers working to eliminate tobacco-related disparities should maintain an active community based infrastructure to improve recruitment of ethically and racial minority smokers in clinical research studies.
Study 2 data is being analyzed to demonstrate the potential of a case management program to increase utilization of smoking cessation counseling and pharmacotherapy.
Study 3 Specific Aim
To describe the strengths and weakness of the intervention and opportunities for improvement.
This will be a qualitative study conducted via semi-structured interviews with participants from Study 2.
This project is innovative. It builds upon our connections with the Latino community, the strengths of mentors in smoking cessation and health systems research, and recent work with smoking cessation. This pilot project will be the first study to explore case management for smoking cessation in safety net clinics identifying and treating either Latino smokers who are patients or Latino smokers who are family members of patients.