Abstract

Background: Tobacco inflicts a tremendous health burden on its users. Veterans use tobacco products at a higher rate than seen in the US adult population. Nearly 16% of African American Veterans and 11% of Hispanic Veterans smoke, compared to 12% of White Veterans. Risk of developing tobacco-related disease is highest for African American Veterans, with higher use of menthol cigarettes than other Veterans increasing burden. Hispanic Veterans are also at elevated risk for developing tobacco-related disease. However, both African American and Hispanic Veterans’ use of evidence-based tobacco cessation treatment in the Veterans Health Administration (VHA) is low, despite the 2019 VHA Directive 1056 updated requirements for increasing access to evidence-based tobacco cessation to Veterans. African American and Hispanic Veterans who use tobacco report greater readiness to quit and are more motivated to quit than White Veterans. High levels of motivation, desire to quit, and acceptability of treatment options should result in high levels of treatment initiation. However, low initiation of treatment may reflect cultural barriers to treatment and the need for tailored strategies to increase use. Significance/Impact: The project aims to improve the health of African American and Hispanic Veterans by addressing health equity and evaluating social determinants of health associated with accessing tobacco cessation treatment use, combining two important HSR&D research priorities. Increasing the proportion of African American and Hispanic Veterans that use tobacco cessation treatment in the VHA would greatly diminish disease burden, prevent mortality, and increase functioning in this underserved population. That, in turn, would decrease the healthcare burden on VHA, as well as the $2.7 billion dollars spent annually on tobacco-related care. Lastly, the project aligns with ORD-wide research priorities to expand historically underrepresented Veterans’ access to quality clinical trials and promotion of equity. Innovation: Project innovations include: 1) focusing on vulnerable and underrepresented African American Veteran and Hispanic population, 2) addressing under-researched health equity in tobacco cessation treatment in VHA, 3) novel use of the population-specific, health communication research methods, and 4) obtaining input from both Veterans and national stakeholders. Specific Aims: The project has 3 aims. Aim 1: Identify barriers and facilitators impacting delivery of tobacco cessation treatment to African American and Hispanic Veterans across facilities within VISN 16. Aim 2: Develop the Engagement, Navigation, and Transmission Intervention for Cessation Efficiency (ENTICE) intervention to increase African American and Hispanic Veteran initiation of tobacco cessation treatment. Aim 3: Conduct a pilot trial of ENTICE for African American and Hispanic Veterans at the Houston VAMC. Methodology: For Aim 1, a mixed-methods evaluation (interviews and VA administrative data) will identify barriers and facilitators of delivery of tobacco cessation treatment to African American and Hispanic Veterans across VISN 16. For Aim 2, the Boot Camp Translation process will integrate patient recommendations to develop two population-specific ENTICE interventions with 8 African American and 8 Hispanic Veterans who use tobacco and 4 African American and 4 Hispanic community members during a full-day retreat followed by 3, 1–3-hour sessions. For Aim 3, a pilot randomized controlled trial will assess the feasibility and acceptability of ENTICE compared to Enhanced Usual Care for 32 African American and Hispanic Veterans tobacco users. Next Steps/Implementation: Strategies and information generated during this project will highlight potential gaps in care that affect African American and Hispanic Veteran health and overall strength of the VHA system by addressing under-researched gaps in health equity. Activities in this project will foster the PI’s growth as an independent VA researcher and allow execution of a line of research that advances health equity in VHA.

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DRA: Health Systems

DRE: Technology Development and Assessment

Keywords: Career Development

MeSH Terms: None at this time.