Institutionalizing a comprehensive tobacco-cessation protocol in an indigenous health system: lessons learned

Area of Science:

• Public Health
• Health Services Research
• Tobacco Control

Background:

• Native Hawaiians experience disproportionately high rates of smoking and lung cancer mortality.
• Addressing these disparities requires effective tobacco cessation interventions tailored to this population.

Purpose of the Study:

• To describe the development and implementation of a comprehensive tobacco cessation protocol within Native Hawaiian Health Care Systems (NHHCS).
• To identify lessons learned in institutionalizing this protocol across multiple healthcare settings.

Main Methods:

• Culturally tailoring the Agency for Healthcare Research and Quality (AHRQ) smoking cessation protocol.
• Tracking process objectives: staff training, Tobacco User Guide Sheet (TUGS) integration, and program expansion.
• Monitoring outcome objectives: smoking status identification, brief intervention delivery, quit date setting, service linkage, and 90-day smoke-free status.

Main Results:

• Adoption of the protocol varied across the five NHHCS after 18 months.
• Greater success in protocol adoption and achieving quit dates was linked to program champions and administrative support.
• Successful NHHCS demonstrated higher rates of smokers setting quit dates and remaining smoke-free for 90 days.

Conclusions:

• Despite collaborative design, each NHHCS implemented the protocol independently.
• Overcoming internal barriers and securing support for tobacco cessation champions are crucial for successful institutionalization.
• Lessons learned can inform other organizations aiming to implement comprehensive tobacco cessation programs.