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Tobacco control efforts in the U.S. have driven smoking prevalence below 20%, yet have left prevalence high in subgroups defined by age, income, education, race/ethnicity and mental health and substance use disorders. These are often stigmatized populations, and many receive healthcare in the public sector. While smoking prevalence is 14% in San Francisco, smoking rates among San Francisco subgroups are up to 25% in LGBT samples, up to 42% among persons enrolled in the San Francisco Health Network (SFHN) safety net, and 70% among persons enrolled in addiction treatment. This application builds a Community Practice-Based Research (CPBR) network, comprised of those service providers who are currently serving low-income and high risk smokers in San Francisco. HealthRight 360 (HR360) is a large addiction treatment provider currently planning to implement tobacco-free grounds policies in all of its programs in January 2017. The San Francisco Health Network (SFHN) is the largest low-income primary care provider in San Francisco, operating 14 clinics throughout the city and serving 66,000 unique persons annually. The CPBR, in this planning phase application, works with nine clinics, however these clinics are part of larger networks with the potential to reach virtually all low income smokers in San Francisco. In the Signature Research Project, working with 3 residential addiction treatment programs, implements and evaluates tobacco free policies, using biochemically verified 7 day abstinence as the primary outcome. The Pilot Demonstration Health Service Research Project, working with 3 SFHN primary care clinics, will perform a mixed-methods needs assessment concerning current tobacco intervention practices, and will pilot test a systems intervention to improve those practices. These activities are supported by an Administrative Core, with partner agencies meeting bi-monthly in working subcommittees, and with all partners meeting in quarterly partnership meetings. The External Advisory Board, with representation of the California Department of Healthcare Services (DCHS) and the San Francisco Department of Public Health (SFDPH) as well as scientific and clinical advisors, meets 3 times with the all partners. CPBR integration with the SFDPH promotes local adoption, collaboration with DHCS supports statewide policy development, and partnership with the Smoking Cessation Leadership Center (SCLC) promotes national dissemination. Last, articulation of the CPBR with the recently announced San Francisco Cancer (SF-CAN) initiative extends the reach and the resources of the CPBR. The long-term goal of the CPBR is to develop strategies to more effectively address tobacco among low-income smokers in San Francisco, to reduce smoking and the associated health, social and economic costs in this population, and to offer a model of integrated low income tobacco control that can inform the work of other communities in California. |
