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Open AccessArticle

Low Burden Strategies Are Needed to Reduce Smoking in Rural Healthcare Settings: A Lesson from Cancer Clinics

1
Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
2
Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA
3
Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
4
Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(5), 1728; https://doi.org/10.3390/ijerph17051728
Received: 31 January 2020 / Revised: 3 March 2020 / Accepted: 3 March 2020 / Published: 6 March 2020
(This article belongs to the Special Issue Tobacco Use and Treatment among Cancer Survivors)
Rural populations face significant smoking-related health disparities, such as a higher prevalence of lung cancer and cancer mortality, higher prevalence of smoking, and lower likelihood of receiving cessation treatment than urban counterparts. A significant proportion of health disparities in rural populations could be eliminated with low-barrier, easy-access treatment delivery methods for smoking cessation. In this study, we assessed treatment engagement among patients in rural and urban settings. Then, we examined the effect of an electronic health record-based smoking cessation module on patient receipt of evidence-based cessation care. As part of a quality improvement project, we retrospectively observed 479,798 unique patients accounting for 1,426,089 outpatient clinical encounters from June 2018–March 2019 across 766 clinics in the greater St. Louis, southern Illinois, and mid-Missouri regions. Smoking prevalence was higher in rural versus urban clinics (20.7% vs. 13.9%, 6.7% [6.3, 7.1], odds ratio = 1.6 [1.6, 1.6], p < 0.0001), and yet rural smokers were nearly three times less likely than their urban counterparts to receive any smoking cessation treatment after adjusting for patients clustering within clinics (9.6% vs. 25.8%, −16.2% [−16.9, −15.5], odds ratio = 0.304 [0.28, 0.33], p < 0.0001). Although not yet scaled up in the rural setting, we examined the effects of a low-burden, point-of-care smoking module currently implemented in cancer clinics. After adjusting for patient clustering within clinics, patients were more likely to receive smoking treatment in clinics that implemented the module versus clinics that did not implement the module (31.2% vs. 17.5%, 13.7% [10.8, 16.6], odds ratio = 2.1 [1.8, 2.6], p < 0.0001). The point-of-care treatment approach offers a promising solution for rural settings, both in and outside the context of cancer care. View Full-Text
Keywords: tobacco use; smoking cessation treatment; cancer care; rural; implementation strategies; electronic health record; decision support; health disparities tobacco use; smoking cessation treatment; cancer care; rural; implementation strategies; electronic health record; decision support; health disparities
MDPI and ACS Style

Ramsey, A.T.; Baker, T.B.; Pham, G.; Stoneking, F.; Smock, N.; Colditz, G.A.; James, A.S.; Liu, J.; Bierut, L.J.; Chen, L.-S. Low Burden Strategies Are Needed to Reduce Smoking in Rural Healthcare Settings: A Lesson from Cancer Clinics. Int. J. Environ. Res. Public Health 2020, 17, 1728.

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