Reducing Tobacco Disparities with Low-income Adults using a Community Health Worker Model-Year 2

The goal of the implementation grant is to create an infrastructure for reaching and treating low-income tobacco users at the Bracken County School-based Health Center by partnering with trusted community and school-based partners who will connect a Community Health Worker (CHW) with tobacco users for tobacco cessation counseling and support. The CHW will work in tandem with a prescriber at Primary Plus to ensure access to tobacco treatment medications for tobacco users who want to quit. We built on the data-driven Community Actions Plans developed during the planning grant. As a result, we identified an opportunity for organizations to partner with the Bracken County Health Department, a well-respected organization with longstanding positive relationships in this tight-knit community, to promote tobacco treatment and prevention. We learned that partner organizations, such as the schools and the new school-based health center as well as local healthcare providers, could expand the reach and promote new avenues to educate community members on the dangers of tobacco use, benefits of quitting, and the need to educate youth at a young age. Aim 1 is to design and implement a CHW/school-based health center (SBHC) partner model to reach and deliver an evidence-based tobacco treatment intervention to adult tobacco users in a rural, under- resourced county. We will train our Primary Plus partner prescribers and school nurses to use a brief intervention, ‘Ask and Act,’ for them to connect our CHW with tobacco users. Aim 2 is to evaluate the ability of the CHW/SBHC partner model to reach, educate, and engage tobacco users in tobacco treatment. We will gather data on # of tobacco users referred to the CHW (reach); # participating in educational activities (educate); # of tobacco users who agree to participate counseling (engage); # completing intake visit (engage). Aim 3 is to examine the impact of the CHW/SBHC partner model to guide delivery of a tobacco treatment intervention on tobacco use patterns, quit attempts and rates of quitting over 1 month. We will collect data on age of initiation, duration, products used, CPD/dependence, importance/confidence in quitting rating, SHS exposure/other tobacco users in home; CO level; # of prior quit attempts, as well as demographics known to impact quitting (e.g., housing, employment status, co-morbidities, etc.). Aim 4 is to identify/explore facilitators and barriers quarterly to implementing the CHW/SBHC partner model with key stakeholders (e.g. health department, school nurses, FRSCY, Primary Plus, dental clinic, faith community, health center committee, school administration) to provide recommendations for sustainability.