Purpose:

To examine how system changes emphasizing participation of professionals and staff in program development and refinement can encourage linkage between clinic-based and neighborhood/peer-based services to encourage nonsmoking among low-income, African American audiences.

Objectives:

Project will be implemented through Grace Hill Health Centers and neighborhood Wellness Initiatives, serving low-income, predominantly African American neighborhoods in St. Louis. System changes will emphasize participatory program development and planning. A Steering Committee with representatives from each Health Center and each neighborhood, along with a Medical Committee of physician representatives from each Health Center, will guide program development. A Task Force will be developed through the Wellness Council in each neighborhood and will provide input to the Steering Committee. These committees will review and adapt AHCPR guidelines for smoking cessation services to the Grace Hill setting and oversee in-service training and program monitoring to promote Key Smoking Cessation Services. Supporting these, Grace Hill’s Patient Tracking System will track, prompt, and quantify provision of Key Services within each Health Center and neighborhood program. It will link Health Center staff and neighborhood staff and volunteers to encourage referral of cases and coordination of services between both settings.

Methodology:

Evaluation will assess implementation of proposed system changes and impacts on Key Smoking Cessation Services in both Health Centers and neighborhood programs. Exit Interviews of smokers from Grace Hill Centers/Neighborhoods and Comparison Centers/Neighborhoods will assess differences in reports of receipt of Key Services. Comparisons of Repeat Survey Cohorts from Grace Hill Centers/Neighborhoods and Comparison Centers/Neighborhoods will also evaluate differences in reported implementation of Key Smoking Cessation Services and in smoking cessation outcomes.