Community Health Worker-delivered tobacco cessation in a small rural county

We evaluated a Community Health Worker (CHW)-Tobacco Treatment Specialist (TTS) model for delivering tailored tobacco treatment counseling and support in a rural, low-resourced county.

This was an exploratory, prospective study of people 18 years or older who used any tobacco product including e-cigarettes or vapes in the past 30 days. The CHW assessed tobacco use, secondhand smoke exposure, and quit history; and collected an expired breath carbon monoxide sample and a brief health history before providing 4-6 in-person or phone-based sessions involving tailored tobacco treatment counseling and support. The CHW connected participants to a prescriber at a federally qualified health care center (FQHC) for cessation medications as needed and/or helped them obtain free or low cost medications as available. Six weeks after intake, the CHW conducted a final in-person assessment, carbon monoxide measurement, and tobacco treatment counseling. We then referred participants to the free Quit line and to their primary care provider or the FQHC for additional treatment.

Median cigarettes smoked per day decreased from 20 at intake to 4.5 at the final visit. Most participants reported at least one or more 24-h quit attempts, and 38% reported they had stopped smoking entirely after the final visit. There was a significant increase in participants' confidence in quitting from intake to final.

Using a CHW-TTS-delivered tobacco treatment approach in a low-resourced rural community demonstrated promise in helping tobacco users quit.