Promising Outcomes of a Culturally Tailored Tobacco Cessation program for High-Risk Populations
Introduction
Despite the decline in overall smoking rates to around 16% in the U.S., rates among persons living with HIV (PLWH) remain high (42% to 70%), resulting in tobacco use being a major cause of morbidity and mortality among the estimated one million PLWH in the U.S. The high prevalence of smoking among PLWH and the fact that nearly two thirds wish to quit suggest there are few efficacious options to treating nicotine dependence among PLWH. As the Administrative Agency for the federally-funded Ryan White HIV/AIDS Programs in Bexar County, University Health’s Navigation to Cessation (N2C) program, an innovative tobacco cessation program for PLWH, employed Certified Tobacco Treatment Specialist Patient Navigators (CTTS PN) to provide cessation services to all PLWH 18 years of age and older. Our primary aim is for our CTTS to adopt a patient navigation model by delivering tailored tobacco cessation services to address our clients’ unique and unmet needs to prevent long-term incidence of lung cancer.
Methods
Three patient navigators (PN) completed the 40-hour UT MD Anderson Cancer Center Certified Tobacco Treatment (CTT) Training Program. Implementing a tobacco prevention media campaign aimed at PLWH as well as engaging the five largest providers of HIV care and support services in Bexar County, N2C enrolled 146 clients living with or at-risk of HIV as of June 2023. The N2C program consists of 3 phases. Phase 1 consists of weekly contacts initiated by the CTT PN and lasts 12 weeks. Contact frequency in Phase 2 decreases to every other week for 8 additional weeks. Phase 3 occurs during the last 4 weeks of the program and provides only one contact by the CTT PN. Face-to-face meetings were at program enrollment, 3 months, and 6 months. Session topics include by are not limited to exploring all aspects of patient’s tobacco use, creating solutions (Plan of Care) that best fits patient’s needs, educating patients on coping skills, discussing withdrawal symptoms, becoming familiar with cessation aids, different types of reduction methods, and helping them identify triggers. To measure program outcomes, clients complete a survey at baseline, 3-months and 6-months about their tobacco history, use of tobacco products (smoking, smokeless, and e-cigarettes), tobacco knowledge, attitudes and beliefs, and quality of life. Clients receive a $25 gift card to a local grocery store as compensation for each completed survey. Preliminary data analyses are focused on the 57 clients with baseline and 3-month follow-up surveys.
Results
Analyses demonstrated marked differences for tobacco use, specifically in the use of manufactured cigarettes, tobacco knowledge and quality of life amongst N2C clients from baseline to 3-months. Furthermore, comparative analyses revealed significant differences in manufactured cigarette use and tobacco knowledge by our clients based on HIV status, with PLWH reported significantly fewer days of manufactured cigarette-use and significantly greater tobacco knowledge.
Conclusion
The use of tailored tobacco cessation services and their role in tobacco use, knowledge and attitudes and quality of life with tobacco users and PLWH suggest that they may be an effective addition to client care.