Reducing Tobacco Disparities with Low-income Adults & Rural Kentucky Communities

Tobacco use continues to disproportionately affect Kentuckians, with 24.6% of adults reporting current smoking compared to 14% nationally. Similarly, youth in Kentucky (KY) report higher rates of tobacco use, with 2,500 youth under 18 becoming daily smokers each year. Kentucky spends almost $2 billion on annual health care costs directly caused by smoking and unfortunately leads the nation in lung cancer and other chronic diseases, leading to premature mortality. Given the lack of progress in rural, low]income communities in Kentucky, we have an opportunity to implement an innovative approach to help build capacity in reducing tobacco use disparities in rural and low]income adults by involving community health workers (CHWs) across the seven IFH KY counties. While CHWs do not traditionally focus on tobacco prevention, nearly all people they serve suffer from tobacco]related diseases. Their responsibilities, which integrate an equity lens, include outreach with disparate populations, community education, informal counseling, and advocacy. Integrating CHWs as leaders in reducing tobacco use disparities and/or enhancing existing coalitions by adding CHWs is a novel strategy with broad application to those striving to reduce tobacco inequities in rural and lower]income communities. The overarching project goal is to identify, engage and inspire CHWs to provide leadership in reducing tobacco use disparities in rural and low]income populations. First, we will create resources data bases for each of the seven Kentucky counties including organizations serving low]income populations and CHWs by type (e.g., patient navigator, doula, family advocate, etc.) and organization (e.g., FQHC, AHEC, hospital). Second, we will conduct focus groups with key stakeholders serving rural and low]income populations in the seven counties and analyze the data for facilitators and barriers related to reducing tobacco disparities. These data will guide our training in rural tobacco disparities. Third, recruit and train CHWs as tobacco treatment specialists in two of the counties (Gallatin and Bracken) to provide public education on tobacco disparities with organizations serving low]income populations in their respective counties. Fourth, hold a webinar training series in rural tobacco disparities for CHWs and other organizations serving low income populations in each of the 7 counties. Our long]term plan is to replicate this approach with the IFH counties in Ohio.