New Demonstration Grant Will Address Tobacco Disparities

PRCHN Associate Director Erika Trapl, PhD, is the Principal Investigator on a one-year, $240,000 Tobacco Disparities Demonstration Project grant from the Ohio Department of Health (ODH). She has become a leading expert on the epidemiology of tobacco use, particularly among youth. One of the unique aspects to this grant is that the project extends work in which the PRCHN is currently engaged as a partner of the Health Improvement Partnership-Cuyahoga (HIP-Cuyahoga) and Healthy Cleveland. Building on the Resident Team model developed by HIP-Cuyahoga, the Tobacco Disparities Project will utilize a multi-level approach to tobacco prevention and cessation by increasing adoption of 100% tobacco-free worksite policies and smoke-free home rules, as well as promoting free resources to assist smokers in quitting (e.g., Ohio QuitLine, smokefreeTXT, QuitGuide, and quitSTART). These strategies will be underpinned by a culturally informed media messaging campaign to raise awareness of dangers of tobacco, particularly cigar products, and encourage smoking cessation.

Tobacco is the leading cause of preventable death in Ohio. Because of that, curbing tobacco use is one of the ODH’s top four strategic priorities for improving the health of Ohioans. The impacts of tobacco are not equally distributed across all Ohioans. Like other health disparities, people with low incomes and low educational attainment bear the highest tobacco-related burdens, meaning these groups are more likely to use tobacco, struggle with quitting or accessing cessation resources, or suffer from secondhand smoke exposure. Tobacco-related disparities also exist in Ohio for people with disabilities, people with mental health or substance abuse disorders, people working in certain occupations, and in the LGBT community. African Americans and pregnant women are additional groups of special concern in Ohio due to the significance of tobacco-related health impacts among these populations.

Multiple factors contribute to racial and socioeconomic disparity in smoking rates and subsequent chronic disease disparities, including smoke-free environment policies, access to tobacco prevention and cessation services, and the lack of culturally specific cessation messaging. Previous research has documented lower cessation rates among low-income African Americans compared to white smokers. However, the researchers believe that African American smokers may have improved outcomes if interventions are culturally specific. Interventions that are rooted in the context of neighborhoods and engage community members to adopt smoke-free policies, promote and increase access to cessation resources, and shift social norms can lower smoking prevalence.

The PRCHN is implementing a multi-level intervention that will use teams of residents trained as community organizers. It’s a similar approach to the Community Health Ambassadors who are working to create health equity within their neighborhoods as part of HIP-Cuyahoga’s REACH grant. The Tobacco Disparities Project will work with resident teams to help implement policy, systems, and environmental changes based on their expert neighborhood knowledge. With focused attention on tobacco prevention and cessation, using a resident team approach has the potential to increase the engagement of community organizations to adopt smoke-free policies and facilitate dissemination of the cessation resources to key constituents.

The PRCHN will implement its intervention in three low-income, predominantly African American neighborhoods using a resident team approach to work with community-serving organizations. The multilevel intervention consists of: 

  • A community-wide targeted mass media health communication component
  • An organization-level component to facilitate adoption of smoke-free workplace policies and adoption and implementation of a system to disseminate cessation resources to constituents
  • Cessation resources at the individual constituent-level to raise awareness and encourage use of tobacco cessation resources and smoke free home policies

The grant allows the PRCHN to demonstrate the effectiveness of its approach so that ODH could replicate it in other parts of the state. The PRCHN will also be part of a tobacco disparities learning collaborative through the state where we can learn from and share with the other two grantees in the state (both of which are at The Ohio State University). To be truly effective, Dr. Trapl notes “tobacco control interventions must reach people in their daily lives. By engaging residents at various venues, people will receive information in a trusted environment and in a culturally relevant way; this can begin to shift tobacco social norms.”