Background: Current smoking in the U.S. disproportionately affects low-income populations with healthcare disparities. Diabetes independently confers substantial atherosclerotic cardiovascular disease risk, and those who smoke have worse health outcomes.

Purpose: To increase screening and cessation services in a priority population through a systems level change.

Methods: A cross-cultural cohort of staff in large safety net health system were trained as tobacco treatment specialists. A bi-lingual (Spanish-English) program coordinator provided outreach to increase awareness and referrals to the tobacco treatment program. Optimization of an electronic medical record enabled an ambulatory smoking cessation framework. Baseline characteristics and abstinence rates at 7-months were compared between the intervention and usual care cohorts. Dichotomous or categorical variables are presented as percentages and compared between groups using Chi-square. Continuous variables are presented as means with standard deviations and compared using independent t-tests using R software version 3.6.1.

Results: From 2018 through 2020, there were 400 referrals. Two-hundred opted into the tobacco cessation program (intervention cohort) and 200 opted out to usual care (control cohort). The average age was 54 years with a mean use of 17 cigarettes per day. Most participants were female (53%), predominantly Hispanic (61%), and received public insurance (88%). In subgroup analyses, 34% and 27% of patients had diabetes in the intervention and usual care cohorts, respectively. The 7-month abstinence rate was 30% versus 5% (p value 0.000) in the intervention versus usual care cohorts, respectively.

Conclusion: Creating a sustainable tobacco cessation pathway within a large health-system improves population health access and quit rates in underserved communities with health disparities.


F. Wang: None. P. A. Allotey: None. M. Vestergaard: None. C. M. D. Vergara: None. J. L. Wilken: None. O. Harel: None.


Connecticut Department of Public Health Tobacco and Health Trust Fund (DPH2017-0097)

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