Leveraging Community-Based Food Pantry Settings for Provision of Tobacco Cessation Treatment

PROJECT SUMMARY/ABSTRACT Commercial tobacco use is disproportionately high among population groups with socioeconomic disadvantage, who continue to face substantial barriers to accessing and using evidence-based cessation services. Engaging with freely accessible tobacco quitlines can significantly increase smoking cessation rates, yet there are socioeconomic disparities in quitline awareness, which impacts subsequent use. Ask-Advise- Connect (AAC), a streamlined Screening, Brief Intervention, and Referral to Treatment (SBIRT) model and health system-based approach to increase uptake of quitline counseling, increases cessation treatment access and improves cessation rates. However, 25-30% of smoking adults, many of whom are low-income, do not visit a primary care provider on an annual basis, and thereby miss the critical opportunity to receive advice and resources to quit. This R01 application seeks to enhance the reach and effectiveness of the tobacco quitline for socioeconomically disadvantaged people who smoke, by building on our prior work leveraging food pantries as a promising community-based setting for tobacco cessation outreach. We will adapt, implement, and examine the sustainability of an adapted AAC model across food pantry settings via the study aims. Aim 1 is to adapt AAC for a community-based setting using participatory co-design, involving stakeholder engagement. Aim 2 is to implement the Community-Adapted Ask-Advise-Connect (CA-AAC) in food pantries to examine the reach and effectiveness. We will conduct a two-arm pragmatic cluster randomized clinical trial (RCT) across 18 pair- matched food pantries, hypothesizing that CA-AAC will have higher reach and higher impact (measured as reach x effectiveness) for quitline engagement than an information-only comparison arm. Aim 3 is to identify multilevel contextual factors that impact the provision of tobacco cessation treatment in food pantries. To inform implementation and sustainability, we will use RE-AIM and PRISM frameworks to examine factors that impact the reach, effectiveness, implementation, and maintenance of CA-AAC in food pantries across contextual domains (multi-level perspectives, multi-level partner characteristics, external environment, and implementation and sustainability infrastructure). This proposal addresses a significant health disparity issue related to the disproportionately high prevalence of tobacco use among socioeconomically disadvantaged groups. This work aligns with priorities of the NIH and National Institute on Minority Health and Health Disparities (NIMHD) in addressing social and structural barriers to promote equitable referral to and engagement in treatment for tobacco cessation, as well as adapting AAC into community-based settings to facilitate linkages to tobacco treatment. By adapting AAC for relevance across a range of food pantry settings and their varying models, this proposal represents a critical opportunity to test and refine implementation strategies that can flexibly and sustainably improve access and uptake of cessation services to a high-need, underserved health disparity group.