ILE Presentation MGH Living Tobacco Free Increasing Use of a Tobacco Cessation and Prevention Program Maria Cerda Diez April 24th, 2018
Revere Smoking rate:23.4% Median Income:$40,487 Everett Smoking rate: 25.0% Median Income:$49,737 Chelsea Smoking rate: 23.4% Median Income:$40,487 Charlestown Smoking rate: 19.0% 18% under the poverty line Source: Tobacco Maps of Massachusetts, 2015 Boston Public Health Commission 2012-2013
Living Tobacco Free Services 1. Cessation Coaching 2. Post-RX Call 3. Pregnancy 4. Post-Discharge Call 5. Soon be: 1x consult
Stages of Changes of Smoking Precontemplation I am not aware my smoking is a problem- I have no intention to quit. Maintenance I am continuing to not smoke. I sometimes miss it- but I am still not smoking. Contemplation I know my smoking is a problem - I want to stop but i have no plans yet. Action I have stopped smoking! Preparation I am making plans & changing things I do in preparation. Source: Prochaska, DiClemente, Norcross, 1992
Current Cigarette and Smokeless Tobacco Use among Adults by Demographic Characteristics in Massachusetts
Target Population The target populations are Hispanic/Latino population, specifically male individuals between 25 and 44 years old, with low levels of education. Some characteristics: Age: 27 years old (median) Annual income:$24,000 Health insurance: 7% does not have Language: 79% Spanish at home Education: 25.4% < high school Source: Pew Research Center, 2014
Revere Latino/Hispanic population: 9.44% Everett Latino/Hispanic population: 9.5% Chelsea Latino/Hispanic population: 48.4% Charlestown Latino/Hispanic population: 11.6% Source: Zip Atlas, 2017
Communication objective: To communicate to patients, the community, and providers about the new 1x consult.
The message The message will include images and testimonial of their peers to increase the level of empowerment It will be tailor to the values, attitudes, norms, and beliefs of the Latino/ Hispanic population The tone will increase their self-efficacy and knowledge Healthcare providers will be the main communication channel
Communication Objectives: Behavioral Objectives 1. Latino/Hispanic patients will make an appointment for 1x consult at one of the MGH LTF facilities. 2. Latino/Hispanic patients will engage with coaches in the LTF program. 3. Latino patients will adhere to treatment given by one of the MGH LTF program healthcare provider. Learning Objectives 1. Latino/Hispanic patients will be aware about MGH smoking cessation program and how they can make an appointment to be part of the program (knowledge). 2. Latino/Hispanic patients will learn how the program work and how is beneficial for them and engage with the smoke cessation treatment (skills/knowledge). 3. Latino/Hispanic patients will understand the impact of stop smoking (increase savings, improved health outcomes, patient self-efficacy) (response efficacy). 4. Latino/Hispanic patients will gain confidence in being able to stop smoking (self-efficacy). 5. Latino/Hispanic patients will believe that MGH smoke cessation program exist to support their pursuit of stop smoking (subjective norms).
Long-Term Objectives The smoking rates of Latino/ Hispanic population will decrease in the underserved populations from Charlestown, Chelsea, Revere and Everett. The impact of preventable health conditions related to tobacco consumption will decrease in the underserved populations from Charlestown, Chelsea, Revere and Everett.
Media Executions
Pitch Letter to Doctors Dear Dr. Michael Sullivan, April 24th, 2018 Have you ever had a patient that is curious about living a life without tobacco but is not ready to quit smoking yet? Do you know that the great majority of these smokers at some point begin thinking about quitting? 1x consult is the service for them. Catch the attention 1x consult is a single judgement-free meeting with a coach that offers: One-on-one meeting A non-threatening conversation Information about resources to quit smoking Techniques about how to deal with cravings and stress Strategies on how to bring your family and friends on board Address any concerns that the patient might have Description
Some of our patients have expressed their wish to see a coach, but they are still not ready to quit smoking. That s why we decided to incorporate 1x consult to our Living TOBACCO FREE program. This service will be a good way to educate patients in a non-threatening way and give them a glimpse of how we might be able to help them in the future. The need & testimonial We would greatly appreciate your help to promote 1x consult service by talking to and referring patients to the service. We know that having you on our side will help us to attract new patients, as physicians are trusted sources among the patient population and are often some of the first to suggest that they quit smoking from a health perspective. 1x consult could be the first step for your patients to quit smoking. Call to action We thank you in advance for your attention and assistance in this matter. Kind regards, Living TOBACCO-FREE Team
Infographic
Testimonial Carlos (37 years old) I've smoked for so long that I did not remember when I started. It is part of my routine. Smoking is the first thing I do in the morning and the last thing I do before I turn off the lights. A couple of months ago I went to the doctor for bronchitis that was not going away. The doctor told me that the cigarette makes it harder and harder for me to breathe, because my lungs are dirty and sick, and that soon I could have an illness that would end my life. I did not know how to respond. Then he gave information about a new service that helps you quit smoking. He told me that it was a single conversation with a coach where I could ask anything about the tobacco and stop smoking. After my appointment, I went back to my house and kept the information on my nightstand. It has been 5 months from that conversation, and I have not stopped thinking about what he told me. I still do not feel ready to quit but I called 1x consult today and next week I ll have my appointment with the coach. I do not lose anything by going, but I m hoping that could gain a lot.
Evaluation Intervention: 1. Number of patient s referrals to 1x consult by providers. 2. Number of patients that make appointments to 1x consult. Communication Strategy: 1. How the new patient learn about the program. 2. What healthcare providers think about the program. 3. Post-consultation survey on quality and satisfaction.
References: 1. Anguiano, B., Brown-Johnson, C., Rosas, L. G., Pechmann, C., & Prochaska, J. J. (2017). Latino Adults Perspectives on Treating Tobacco Use Via Social Media. JMIR mhealth and uhealth, 5(2), e12. http://doi.org/10.2196/mhealth.6684 2. Boston Public Health Commission. (2013). Health of Boston 2012-2013. A Neighborhood focus. Retrieved from: http://www.bphc.org/healthdata/health-of-boston-report/documents/hob-2012-2013/hob12-13_fullreport.pdf 3. Centers for Disease Control and Prevention. (2012). Smoking & Tobacco Use. Retrieved from: https://www.cdc.gov/tobacco/data_statistics/state_data/state_highlights/2012/states/massachusetts/index.htm 4. Koyun, A., Eroglu, K. (2013). The transtheoretical model use for smoking cessation. International Association of Social Science Research, 130-134. Retrieved from: http://iassr2.org/rs/020319.pdf 5. MAHB. Tobacco Maps of Massachusetts. Retrieved from: http://www.mahb.org/tobaccomaps/ 6. Pew Research Center. (2014). Demographic profile of Hispanic in Massachusetts, 2014. Retrieved from: http://www.pewhispanic.org/states/state/ma/ 7. Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. (1992). In search of how people change: Applications to the addictive behaviors. American Psychologist, 47, 1102-1114. PMID: 1329589. 8. Woodruff SI, Talavera GA, Elder JP. (2002). Evaluation of a culturally appropriate smoking cessation intervention for Latinos Tobacco Control.11:361-367. http://dx.doi.org/10.1136/tc.11.4.361 9. Webb, M.S., Rodriguez-Esquivel, D., Baker, E.A, (2010). Smoking Cessation Interventions among Hispanics in the United States: A Systematic Review and Mini Meta-Analysis. American Journal of Health Promotion. Retrieved from: http://journals.sagepub.com/doi/abs/10.4278/ajhp.090123-lit-25?url_ver=z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3d pubmed#articlecitationdownloadcontainer 10. ZipAtlas. (2017). Cities with the Highest Percentage of Hispanic in Massachusetts. Retrieved from: http://zipatlas.com/us/ma/city-comparison/percentage-hispanic-population.htm