PROJECT 2

Although smoking rates are declining, they remain elevated among individuals impacted by poverty (36%). Tobacco use remains an important modifiable risk factor for cancer and an urgent public health priority. Despite elevated smoking rates, low-income smokers have less awareness of, access to, and utilization of smoking cessation treatments. Federally Qualified Health Centers (FQHCs), safety-net care settings for the most vulnerable populations, represent an important yet under-appreciated opportunity for reducing smoking- related health inequalities. In 2012, 21 million patients, the majority of whom were either uninsured (36%) or publicly insured (49%), received care at an FQHC. Innovation is needed to increase access to smoking cessation treatments among low-income smokers treated in FQHC practices serving PPA patients. Evidence shows that provider screening, counseling, and pharmacotherapy reduces tobacco use. However, consistent delivery of provider-led cessation treatments in clinical settings is challenging. State tobacco quitlines are effective, free or low-cost, and available in all states. Nevertheless, quitline usage is limited. The Centers for Disease Control recommends proactive strategies for increasing quitline use, including partnerships with health care centers. Electronic health record-linked patient portals are becoming a standard part of health care delivery and are a novel approach for proactively linking smokers to Quitlines. Evidence supports the reach and feasibility of portals for offering population-based interventions. However, prior studies have not tested implementation strategies for using portals to offer proactive linkage to quitlines. Informed by Social Determination Theory, Project 2 will evaluate the implementation of three scalable strategies, including (1) patient navigation, (2) widely available health information technology (HIT) infrastructure including the patient portal, for offering proactive linkage of low-income smokers and (3) the New York State Smoker's Quit Line (NYSSQL). We propose a population-based randomized trial in three FQHCs in SoCa neighborhoods. First, we will examine the effectiveness of an educational campaign paired with patient navigation for increasing patient portal enrollment (Aim 1). Next, we will evaluate the reach of the patient portal as an approach to delivering population-level advice to quit and smoking cessation treatment linkage (Aim 2). We will compare impact of referral type (opt-in referral vs. self-referral) on linkage to the NYSSQL (Aim 3). Aim 4 will compare the influence of message type (Arm 1 Choice vs. Arm 2 No-Choice in cessation goals) on rates of linkage to the NYSSQL and receipt of smoking cessation treatment. This project aligns with the SoCa mission of addressing health disparities in persistent poverty areas by improving health through tobacco cessation and overall portal health enrollment for future cancer screening outreach and cancer control measures.