PROJECT 2

虽然吸烟率正在下降，但受贫困影响的个人的吸烟率仍然很高（36%）。 烟草使用仍然是一个重要的可改变的癌症风险因素，也是一个紧迫的公共卫生优先事项。 尽管吸烟率上升，但低收入吸烟者对吸烟的认识、获得和利用程度较低， 戒烟治疗。联邦合格的卫生中心， 最脆弱的人群，代表了减少吸烟的重要但未得到充分重视的机会， 与健康不平等有关。2012年，2100万患者，其中大多数要么没有保险（36%）， 有公共保险的人（49%）在一家医疗保健中心接受护理。需要创新来增加吸烟的机会 在为PPA患者提供服务的CNOHC实践中接受治疗的低收入吸烟者的戒烟治疗。 有证据表明，提供者筛选，咨询和药物治疗可以减少烟草使用。 然而，在临床环境中持续提供由提供者主导的戒烟治疗是具有挑战性的。状态 戒烟热线是有效的、免费或低成本的，在所有州都可以使用。然而，退出线的使用是 有限公司疾病控制中心建议增加戒烟线使用的积极策略，包括 与医疗保健中心合作。电子健康记录链接的患者门户网站正在成为一种标准 这是医疗保健服务的一部分，也是主动将吸烟者与戒烟热线联系起来的一种新方法。证据 支持提供基于人口的干预措施的门户网站的覆盖面和可行性。然而，先前的研究 尚未测试使用门户网站主动联系戒烟热线的实施战略。 根据社会决定理论，项目2将评估三个可扩展的 战略，包括（1）患者导航，（2）广泛使用的健康信息技术（HIT） 基础设施，包括病人门户网站，为低收入吸烟者提供主动联系，以及（3）新的 约克州戒烟热线（NYSSQL）。我们提出了一项基于人群的随机试验， SoCa社区首先，我们将检查教育活动的有效性， 导航以增加患者入口入组（目标1）。接下来，我们将评估患者入口的范围 作为一种提供人群戒烟建议和戒烟治疗联系的方法（目标2）。 我们将比较转介类型（选择性转介与自我转介）对与NYSSQL（目标3）联系的影响。目的 4将比较消息类型（第1组选择与第2组无选择戒烟目标）对发生率的影响 与NYSSQL的联系和接受戒烟治疗。该项目符合SoCa 通过吸烟改善健康状况，解决持续贫困地区健康差距的使命 用于未来癌症筛查外展和癌症控制的停止和总体门户健康登记 措施

Although smoking rates are declining, they remain elevated among individuals impacted by poverty (36%). Tobacco use remains an important modifiable risk factor for cancer and an urgent public health priority. Despite elevated smoking rates, low-income smokers have less awareness of, access to, and utilization of smoking cessation treatments. Federally Qualified Health Centers (FQHCs), safety-net care settings for the most vulnerable populations, represent an important yet under-appreciated opportunity for reducing smoking- related health inequalities. In 2012, 21 million patients, the majority of whom were either uninsured (36%) or publicly insured (49%), received care at an FQHC. Innovation is needed to increase access to smoking cessation treatments among low-income smokers treated in FQHC practices serving PPA patients. Evidence shows that provider screening, counseling, and pharmacotherapy reduces tobacco use. However, consistent delivery of provider-led cessation treatments in clinical settings is challenging. State tobacco quitlines are effective, free or low-cost, and available in all states. Nevertheless, quitline usage is limited. The Centers for Disease Control recommends proactive strategies for increasing quitline use, including partnerships with health care centers. Electronic health record-linked patient portals are becoming a standard part of health care delivery and are a novel approach for proactively linking smokers to Quitlines. Evidence supports the reach and feasibility of portals for offering population-based interventions. However, prior studies have not tested implementation strategies for using portals to offer proactive linkage to quitlines. Informed by Social Determination Theory, Project 2 will evaluate the implementation of three scalable strategies, including (1) patient navigation, (2) widely available health information technology (HIT) infrastructure including the patient portal, for offering proactive linkage of low-income smokers and (3) the New York State Smoker's Quit Line (NYSSQL). We propose a population-based randomized trial in three FQHCs in SoCa neighborhoods. First, we will examine the effectiveness of an educational campaign paired with patient navigation for increasing patient portal enrollment (Aim 1). Next, we will evaluate the reach of the patient portal as an approach to delivering population-level advice to quit and smoking cessation treatment linkage (Aim 2). We will compare impact of referral type (opt-in referral vs. self-referral) on linkage to the NYSSQL (Aim 3). Aim 4 will compare the influence of message type (Arm 1 Choice vs. Arm 2 No-Choice in cessation goals) on rates of linkage to the NYSSQL and receipt of smoking cessation treatment. This project aligns with the SoCa mission of addressing health disparities in persistent poverty areas by improving health through tobacco cessation and overall portal health enrollment for future cancer screening outreach and cancer control measures.