Individuals without health insurance are 1} times more likely to smoke than those insured through private providers and are less likely to receive smoking cessation advice from a health professional. Limited access to smoking cessation programs among the uninsured may contribute to their excess disease burden and poorer survival. The goal of this research is to provide formative data on the implementation and dissemination of evidence-based tobacco cessation strategies in free clinics by achieving the following aims: (1) increasing free clinics'organizational readiness to adopt the United States Public Health Service's Guidelines on Treating Tobacco Use and Dependence;(2) evaluating the efficacy of the evidence-based strategies in promoting tobacco cessation behaviors among the clinics'health care volunteers and uninsured patients;and (3) testing whether the North Carolina Association of Free Clinics has the capacity to disseminate the evidence-based tobacco prevention and cessation strategies in absence of the university research team. These aims will be accomplished through a randomized, controlled trial design to test the adoption, efficacy, and dissemination of clinic-based tobacco cessation strategies in six free clinics. These aims will be evaluated using three data collection protocols including key informant interviews, environmental scans, and patient exit interviews. Free clinics serve a critical role in health care delivery of America's uninsured population. They are non-profit private entities distinct from other safety net providers in that they do not accept reimbursement from any third-party payors, do not charge patients for health care services, and rely extensively on volunteer health care professionals. More than 300,000 patient visits occurred in North Carolina's free clinics in 2006. Of 55 free clinics in North Carolina providing medical or dental care , only one out of four clinics offers any tobacco cessation services and only two have a comprehensive tobacco cessation program onsite. The proposed research study responds to an unmet need for the successful implementation and dissemination of evidence-based tobacco cessation care for the uninsured. The overall intent of this research is to ultimately close the gap between research discovery and program delivery in the area of tobacco control. PUBLIC HEALTH RELEVANCE: The scientific evidence demonstrates that comprehensive clinic-based interventions significantly improve quit rates among tobacco-using patients. The evidence is also compelling that individuals without health insurance are less likely to receive tobacco cessation counseling, yet are more than 1 } times the general population to use tobacco. This study will test the implementation and dissemination of evidence-based clinical practice guidelines in the free clinic setting, whereby having a significantly positive impact on the health of the uninsured.

R21DA024631

2009-08-15

2011-07-31