@article{Robertson_Mamudu_Littleton_Boghozian_Owusu_Collins_Wang_Sreenivas_2017, title={Using a Collaborative Approach to Tobacco Control Efforts in Marginalized Communities}, volume={9}, url={https://ojphi.org/ojs/index.php/ojphi/article/view/7653}, DOI={10.5210/ojphi.v9i1.7653}, abstractNote={<div style="left: 82px; top: 278.58px; font-size: 12.9074px; font-family: sans-serif; transform: scaleX(1.08211);" data-canvas-width="58.10914814814815">Objective</div><div style="left: 95.6667px; top: 292.202px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.993484);" data-canvas-width="347.0737314814813">To examine community engagement as a means to strengthen</div><div style="left: 82px; top: 307.387px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.04348);" data-canvas-width="364.1050555555553">tobacco-related policies and programs use in marginalized</div><div style="left: 82px; top: 322.572px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.0013);" data-canvas-width="63.465722222222226">populations.</div><div style="left: 82px; top: 348.431px; font-size: 12.9074px; font-family: sans-serif; transform: scaleX(1.11815);" data-canvas-width="75.28890740740741">Introduction</div><div style="left: 95.6667px; top: 362.054px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00126);" data-canvas-width="344.81622592592595">Although significant progress has been made in tobacco control in</div><div style="left: 82px; top: 377.239px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.01548);" data-canvas-width="358.8865907407407">the United States (US) over the past 50 years, more than 15% of the</div><div style="left: 82px; top: 392.424px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.03233);" data-canvas-width="226.50951111111115">population currently use tobacco products.</div><div style="left: 308.391px; top: 392.765px; font-size: 7.74444px; font-family: serif;">1</div><div style="left: 312.307px; top: 392.424px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.0511);" data-canvas-width="129.28575555555557">Tobacco use continues</div><div style="left: 82px; top: 407.609px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.963365);" data-canvas-width="359.83270370370377">to be the leading cause of preventable death, contributing to over</div><div style="left: 82px; top: 422.794px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.02272);" data-canvas-width="359.1963685185185">480,000 deaths and about $300 billion in economic costs each year.</div><div style="left: 82px; top: 437.98px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.973877);" data-canvas-width="85.61999629629632">To achieve the</div><div style="left: 167.604px; top: 437.98px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.998025);" data-canvas-width="114.35704814814817">Healthy People 2020</div><div style="left: 281.938px; top: 437.98px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.85369);" data-canvas-width="9.177166666666666">(</div><div style="left: 291.232px; top: 437.98px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.03668);" data-canvas-width="43.7651462962963">HP2020</div><div style="left: 334.985px; top: 437.98px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.95951);" data-canvas-width="107.24119444444447">) objective of 12%</div><div style="left: 82px; top: 453.165px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.97037);" data-canvas-width="360.46000370370353">national adult smoking rate by 2020, it is important to focus our</div><div style="left: 82px; top: 468.35px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.99082);" data-canvas-width="360.2289611111111">tobacco control efforts on surveillance and addressing disparities</div><div style="left: 82px; top: 483.535px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.02337);" data-canvas-width="361.26671666666675">in tobacco use prevalence and tobacco-induced diseases across</div><div style="left: 82px; top: 498.72px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.05193);" data-canvas-width="266.73544629629623">different subpopulations and geographic areas.</div><div style="left: 348.677px; top: 499.062px; font-size: 7.74444px; font-family: serif;">2</div><div style="left: 352.709px; top: 498.72px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.04702);" data-canvas-width="91.43994629629631">Utah reported</div><div style="left: 82px; top: 513.905px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.963605);" data-canvas-width="360.2599388888888">the lowest prevalence rate (9.7% in 2014), while rates as high as</div><div style="left: 82px; top: 529.091px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.97899);" data-canvas-width="359.97468518518514">28% were identified in central Appalachia. Modern epidemiology</div><div style="left: 82px; top: 544.276px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.02377);" data-canvas-width="361.6655555555553">is limited in its ability to explain patterns of tobacco use and</div><div style="left: 82px; top: 559.461px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.02147);" data-canvas-width="359.47258703703676">tobacco-related interventions and policies in these highly prevalent,</div><div style="left: 82px; top: 574.646px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.999014);" data-canvas-width="358.42966851851855">marginalized environments. Therefore, a combination of quantitative</div><div style="left: 82px; top: 589.831px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.978052);" data-canvas-width="359.6132777777777">and community-based participatory research (CBPR), as proposed</div><div style="left: 82px; top: 605.017px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.969665);" data-canvas-width="360.47291111111093">in Public Health 3.0, will expand the scope and reach to address</div><div style="left: 82px; top: 620.202px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.961251);" data-canvas-width="359.65199999999993">all factors of tobacco use, including cross-sector collaboration and</div><div style="left: 82px; top: 635.387px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.994324);" data-canvas-width="98.93527777777776">multi-level actions.</div><div style="left: 180.945px; top: 635.728px; font-size: 7.74444px; font-family: serif;">3</div><div style="left: 184.81px; top: 635.387px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.985996);" data-canvas-width="255.24140000000003">This study aimed to comprehensively investigate</div><div style="left: 82px; top: 650.572px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.02899);" data-canvas-width="361.58552962962955">counties in the Northeast Tennessee region where tobacco use</div><div style="left: 82px; top: 665.757px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.995763);" data-canvas-width="360.4496777777776">prevalence is disproportionately highest, and to identify regional</div><div style="left: 82px; top: 680.943px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.01677);" data-canvas-width="359.17571666666663">and culturally specific evidence-based practices for tobacco control.</div><div style="left: 82px; top: 696.128px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.02573);" data-canvas-width="359.3486759259258">Additionally, the study examined how these practices can be scaled</div><div style="left: 82px; top: 711.313px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.988158);" data-canvas-width="358.1250537037037">up to address similar high tobacco use and disadvantaged populations</div><div style="left: 82px; top: 726.498px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00144);" data-canvas-width="187.1186851851852">elsewhere in the US and worldwide.</div><div style="left: 82px; top: 752.357px; font-size: 12.9074px; font-family: sans-serif; transform: scaleX(1.07341);" data-canvas-width="53.062351851851844">Methods</div><div style="left: 95.6667px; top: 765.979px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.96783);" data-canvas-width="346.20893518518506">Grounded by the CBPR framework, a mixed-methods approach</div><div style="left: 82px; top: 781.165px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00297);" data-canvas-width="358.6452222222222">triangulated multiple sources of data using a three-prong assemblage</div><div style="left: 82px; top: 796.35px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.04153);" data-canvas-width="14.546648148148146">of</div><div style="left: 100.354px; top: 796.35px; font-size: 12.9074px; font-family: serif;">P</div><div style="left: 108.521px; top: 796.35px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.05572);" data-canvas-width="55.17916666666667">rotection,</div><div style="left: 167.483px; top: 796.35px; font-size: 12.9074px; font-family: serif;">P</div><div style="left: 175.65px; top: 796.35px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.05946);" data-canvas-width="88.37701851851854">revention, and</div><div style="left: 264px; top: 796.35px; font-size: 12.9074px; font-family: serif;">C</div><div style="left: 273.604px; top: 796.35px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.05736);" data-canvas-width="170.81662962962963">essation, to develop tobacco</div><div style="left: 82px; top: 811.535px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.955789);" data-canvas-width="359.44031851851855">control recommendations and goals as part of a Population Health</div><div style="left: 82px; top: 826.72px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.979604);" data-canvas-width="359.9553240740739">Improvement Plan for Tennessee. Information gained from health</div><div style="left: 82px; top: 841.905px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.04589);" data-canvas-width="362.1031166666664">council discussions, focus groups, interviews, and stakeholder</div><div style="left: 82px; top: 857.091px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.988387);" data-canvas-width="360.2341240740744">meetings were combined with quantitative analyses of secondary</div><div style="left: 82px; top: 872.276px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.972932);" data-canvas-width="359.9036944444447">data from Tennessee Department of Health, school-based surveys,</div><div style="left: 82px; top: 887.461px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.988817);" data-canvas-width="360.4238629629632">and qualitative analyses conducted for descriptive and inferential</div><div style="left: 82px; top: 902.646px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.03648);" data-canvas-width="359.69201296296274">statistics. All discussions and interviews involving 222 individuals</div><div style="left: 82px; top: 917.831px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.981542);" data-canvas-width="360.0134074074074">from 91 organizations were recorded and organized using NVivo</div><div style="left: 82px; top: 933.017px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.963837);" data-canvas-width="359.4790407407406">10, thematically coded using grounded theory, and analyzed using</div><div style="left: 82px; top: 948.202px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.979825);" data-canvas-width="358.10956481481446">descriptive statistics. The results utilized aggregated themes generated</div><div style="left: 82px; top: 963.387px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00138);" data-canvas-width="72.04914814814813">from the data.</div><div style="left: 82px; top: 989.246px; font-size: 12.9074px; font-family: sans-serif; transform: scaleX(1.08548);" data-canvas-width="46.62155555555556">Results</div><div style="left: 95.6667px; top: 1002.87px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.989532);" data-canvas-width="344.2250666666667">Tobacco use in the Northeast Tennessee region comprises cigarette</div><div style="left: 82px; top: 1018.05px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.994982);" data-canvas-width="358.3096296296294">smoking and smokeless tobacco, with increasing uptake of electronic</div><div style="left: 82px; top: 1033.24px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.959146);" data-canvas-width="359.8714259259256">cigarettes across all age groups. Among others, culture of tobacco</div><div style="left: 82px; top: 1048.42px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.99933);" data-canvas-width="360.7749444444447">use and cultivation was identified as the most salient factor for</div><div style="left: 82px; top: 1063.61px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.968874);" data-canvas-width="359.79139999999995">tobacco use. Reducing tobacco use requires a foundation built on</div><div style="left: 82px; top: 1078.79px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.982101);" data-canvas-width="360.15280740740735">informatics, community engagement, and a model for sustainable</div><div style="left: 82px; top: 1093.98px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.03212);" data-canvas-width="359.4687148148149">funding to support infrastructure and program interventions. While</div><div style="left: 82px; top: 1109.16px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00848);" data-canvas-width="358.8491592592592">state and national policies and programs have received less attention</div><div style="left: 464.667px; top: 277.017px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.03655);" data-canvas-width="361.65264814814816">in this region, several effective community-based policies and</div><div style="left: 464.667px; top: 292.202px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00601);" data-canvas-width="358.67490925925915">programs to prevent tobacco use were identified, including incentive</div><div style="left: 464.667px; top: 307.387px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.02023);" data-canvas-width="361.2292851851852">programs such as Baby and Me, voluntary smoke-free campus</div><div style="left: 464.667px; top: 322.572px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.971224);" data-canvas-width="360.00049999999993">policies by businesses and colleges, 100% screening programs by</div><div style="left: 464.667px; top: 337.757px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.02007);" data-canvas-width="359.30349999999993">hospitals, and nicotine-free employee population. Overall, a total of</div><div style="left: 464.667px; top: 352.942px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.967969);" data-canvas-width="359.79398148148164">25 recommendations were identified, with 14 aimed at protection,</div><div style="left: 464.667px; top: 368.128px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.03207);" data-canvas-width="359.45322592592595">four at prevention, and seven at cessation. These recommendations</div><div style="left: 464.667px; top: 383.313px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.02132);" data-canvas-width="209.5401425925926">culminated into five overarching goals:</div><div style="left: 674.199px; top: 383.313px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.04156);" data-canvas-width="37.9994074074074">Protect</div><div style="left: 712.19px; top: 383.313px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.02611);" data-canvas-width="111.72651851851852">the population from</div><div style="left: 464.667px; top: 398.498px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.988577);" data-canvas-width="358.09536666666656">tobacco and secondhand smoke exposure through policy enforcement</div><div style="left: 464.667px; top: 413.683px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.0077);" data-canvas-width="244.40175925925928">and implementation and counter-marketing;</div><div style="left: 709.064px; top: 413.683px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.04768);" data-canvas-width="41.22625925925926">Prevent</div><div style="left: 750.286px; top: 413.683px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.978237);" data-canvas-width="75.03075925925926">initiation of</div><div style="left: 464.667px; top: 428.868px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.972703);" data-canvas-width="357.9224074074073">tobacco use with comprehensive youth-focused programs that increase</div><div style="left: 464.667px; top: 444.054px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00277);" data-canvas-width="141.77496296296295">knowledge and awareness;</div><div style="left: 606.431px; top: 444.054px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00166);" data-canvas-width="39.43212962962962">Expand</div><div style="left: 645.859px; top: 444.054px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00355);" data-canvas-width="177.44458333333336">access to cessation resources and</div><div style="left: 464.667px; top: 459.239px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.03896);" data-canvas-width="248.12167407407395">treatment, especially in high risk populations;</div><div style="left: 712.69px; top: 459.239px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.05986);" data-canvas-width="34.14525555555555">Foster</div><div style="left: 746.824px; top: 459.239px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.03975);" data-canvas-width="77.40959444444445">collaboration</div><div style="left: 464.667px; top: 474.424px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00122);" data-canvas-width="108.61583333333336">and partnership; and</div><div style="left: 573.27px; top: 474.424px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00222);" data-canvas-width="42.310481481481474">Monitor</div><div style="left: 615.579px; top: 474.424px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00642);" data-canvas-width="167.7704814814815">data for evaluation and validity.</div><div style="left: 464.667px; top: 503.32px; font-size: 12.9074px; font-family: sans-serif; transform: scaleX(1.10391);" data-canvas-width="77.45735185185185">Conclusions</div><div style="left: 478.333px; top: 516.943px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.981869);" data-canvas-width="344.5542055555555">This is one of the few comprehensive attempts to address the social</div><div style="left: 464.667px; top: 532.128px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.986887);" data-canvas-width="360.54261111111117">dynamics of tobacco use and identify population and geographic</div><div style="left: 464.667px; top: 547.313px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00668);" data-canvas-width="360.89627407407374">policies and programs in highly prevalent communities. Among</div><div style="left: 464.667px; top: 562.498px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.967648);" data-canvas-width="360.0779444444443">the myriad issues identified, the expansion of surveillance data to</div><div style="left: 464.667px; top: 577.683px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.973032);" data-canvas-width="359.60037037037057">inform tobacco policy and culturally-tailored tobacco policies and</div><div style="left: 464.667px; top: 592.868px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.983461);" data-canvas-width="358.0127592592593">programs are essential to reduce tobacco use in population subgroups.</div><div style="left: 464.667px; top: 608.054px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.01256);" data-canvas-width="361.2137962962964">Combining CBPR with actionable data can spur innovations in</div><div style="left: 464.667px; top: 623.239px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.02546);" data-canvas-width="359.18604259259274">local efforts, highlight social determinants of health, and contribute</div><div style="left: 464.667px; top: 638.424px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.959034);" data-canvas-width="359.47775">to evidence-based policy. While the results of this study primarily</div><div style="left: 464.667px; top: 653.609px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.995837);" data-canvas-width="358.20249814814815">provide in-depth descriptions of central Appalachia’s tobacco-related</div><div style="left: 464.667px; top: 668.794px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.968264);" data-canvas-width="359.935962962963">risks and their perceptions of and reactions to tobacco prevention</div><div style="left: 464.667px; top: 683.979px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.99237);" data-canvas-width="358.1134370370371">intervention, the policies and programs identified through the process</div><div style="left: 464.667px; top: 699.165px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00051);" data-canvas-width="358.53421851851834">may be more readily adopted and scaled-up to address the disparities</div><div style="left: 464.667px; top: 714.35px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.01443);" data-canvas-width="359.1421574074074">in tobacco use and tobacco-induced diseases, particularly pertaining</div><div style="left: 464.667px; top: 729.535px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00148);" data-canvas-width="319.75520370370356">to low-income, disadvantaged, and hard-to-reach populations.</div>}, number={1}, journal={Online Journal of Public Health Informatics}, author={Robertson, Crystal and Mamudu, Hadii M. and Littleton, Mary Ann and Boghozian, Rafie and Owusu, Daniel and Collins, Candice and Wang, Liang and Sreenivas, Veeranki P.}, year={2017}, month={May} }