AAFP Tobacco Control Mini-grant Recipients Get Creative Again

July 13, 2016 02:07 pm Chris Crawford

After a successful inaugural year of awarding tobacco and nicotine prevention and control mini-grants, the Academy's second class of recipients has again created innovative programs to control tobacco use at the state and local levels.

Kansas AFP volunteers provide tobacco control educational materials, participation gifts and snacks at one of seven "neighborhood conversation" events that were funded by an AAFP tobacco and nicotine prevention and control mini-grant.

The AAFP awarded 10 chapters and residency programs grants of $4,000 each to help promote healthy interventions to prevent and treat tobacco use and nicotine dependence.

All AAFP chapters and family medicine residency programs accredited by the Accreditation Council for Graduate Medical Education in the United States were eligible to apply for this year's mini-grants. Grants went to recipients who implemented action plans with measurable goals in one of three key focus areas:

  • office-based tools,
  • community engagement and
  • advocacy.

The grants were made possible with support from the AAFP Foundation.(www.aafpfoundation.org)

AAFP News spoke with three mini-grant recipients about their accomplishments and takeaways from participating in the program.

Story highlights
  • The Academy has announced its second class of tobacco and nicotine prevention and control mini-grant recipients.
  • The AAFP awarded 10 chapters and residency programs grants of $4,000 each to help promote healthy interventions to prevent and treat tobacco use and nicotine dependence.
  • Chapters and residency programs can apply for the 2016-17 tobacco and nicotine prevention and control mini-grants until Aug. 15.

Residency Seeks to Reduce Smoking During Pregnancy

Kaylene Niemiller, operations manager for the Deaconess Family Medicine Residency(85 KB PDF) in Evansville, Ind., told AAFP News the group's project was inspired by the unfortunate fact that 54 percent of its prenatal patients said they smoked during pregnancy.

In light of that startling statistic, the residency sought to enroll 50 women in a program that aimed to reduce the number of patients who smoke during pregnancy by about 5 percent and get 90 percent of participants to abstain from smoking at 12 months postpartum.

"We have a very high population of indigent patients we attribute this to," she said. For example, within Deaconess' prenatal patient population, 99 percent qualify for the state's Medicaid program.

"A lot of the attitudes the residents report from their patient interactions are driven by a lack of knowledge and the fact that (these patients) listen more to their peer groups than to the resident physicians," Niemiller said. "We hear a lot of 'I smoked during my last pregnancy and nothing bad happened,' 'So-and-so smoked and nothing bad happened to their baby,' as well as 'I want a smaller baby so it's easier to deliver.'"

To support its goals, the residency program partnered with the Vanderburgh County Health Department to present the Baby & Me Tobacco Free(www.babyandmetobaccofree.org) curriculum. Residents worked with the facility's public health nurse to identify patients who would benefit from the class, and then the nurse presented the materials to these expectant mothers each week.

In addition, the residents created a video(deaconess.wistia.com) to be shown during the class that touts the importance of remaining smoke-free throughout pregnancy.

"While creating a script for the patients, (residents) were forced to think very thoughtfully about how they worded communication in a way that patients could possibly identify with and understand," Niemiller said. "It forced them to really develop their 'elevator speech' to patients about smoking and the effects of smoking on their pregnancy and unborn child."

Kansas AFP Targets Tobacco Advertising

Tara Nolen, M.P.H., tobacco control coordinator for the Kansas AFP(818 KB PDF), told AAFP News her chapter's project was an extension of the Tobacco Free Wichita Coalition's (TFWC) 2014 tobacco retailer assessment, which showed 40 percent of all tobacco licenses in Wichita are located in six ZIP codes with the lowest reported average household income, and more than 70 percent of tobacco retailers are within a half-mile of a school or a park.

With the help of the AAFP mini-grant and a grant from the Kansas Health Foundation, the Kansas AFP coordinated efforts for the TFWC to conduct "neighborhood conversations" in these six ZIP codes with those most targeted by tobacco ads (youth; African-Americans; members of the lesbian, gay, bisexual and transgender community; people of low socioeconomic status; and pregnant women). These conversations were conducted at seven events in the areas of concern to educate attendees and raise awareness about the advertising tactics tobacco companies employ.

The group spoke with 106 adults and 30 youths. More than 40 percent of attendees said they had used some form of tobacco/nicotine product (including e-cigarettes) in the past 12 months.

"However, these (attendees) were highly supportive of a variety of local policy changes to reduce the impact of tobacco advertising," Nolen said. "This leads me to believe that people at risk or who use tobacco products want to find a way to reduce the temptations for youth and reduce their own struggles associated with addiction."

And she said some attendees brought up other evidence-based strategies for addressing tobacco control that were not discussed by the facilitators. "This shows that talking directly with the affected communities about health issues can lead to effective solutions that they can support, once they are provided adequate knowledge," Nolen said.

Additionally, the Kansas AFP sought to gain support from these communities for future policy initiatives that it and the TFWC could use to further reduce the impact of tobacco ads.

"Tobacco advertising is not something that people instinctively relate to an increased prevalence of smoking," she said. "However, education of the subject set the platform for productive conversations and possible solutions from the populations most at risk. I think this process was highly successful at starting a dialogue that will lead to positive changes."

Residency Enhances Education, Helps Homeless

Philip Day, Ph.D., curriculum educator for the family medicine residency in the department of family and community medicine at the University of Texas Southwestern Medical Center(94 KB PDF) in Dallas, told AAFP News that previously, residents in the program didn't receive specific training in smoking cessation techniques because they could refer patients to the Parkland Smoking Cessation Clinic.

But this process created a gap in these residents' education, so they weren't best equipped to treat patients for smoking cessation after they went into practice on their own.

Thus, one element of the group's mini-grant project was to create dedicated motivational interviewing lectures for residents on smoking cessation. A baseline survey to determine residents' needs for smoking curricula was used to establish resources, which are being designed and implemented by third-year chief resident William Nutting II, M.D., for the 2016-17 residency year.

In addition, a lead preceptor faculty member was chosen to train as a tobacco treatment specialist this year and help train the next class of residents.

As a second element of the project, the residency purchased smoking cessation therapies (nicotine patches and gum) and also a Smokerlyzer device used to measure carbon monoxide (CO) levels in the breath to treat homeless men at community partner Calvert Place Clinics in Dallas.

Throughout the duration of the mini-grant, 14 residents participated in a one-month community medicine rotation that includes assisting in smoking cessation sessions at the homeless shelter.

"I would like to emphasize that the Smokerlyzer was really motivational in the homeless shelters and added a sort of soft peer pressure to see who could achieve the 'best' decline in CO levels," Day said.

As for additional tobacco control efforts, the residency program has discussed the possibility of creating shared medical appointments for patients who want to quit smoking, he said.

"Also, the medical student arm of the project is continuing, but as a research study (pending institutional review board approval) to see how effectively this kind of therapy, counseling, and (now) wellness and relaxation classes can aid homeless individuals in cessation," Day said.

2016-17 Tobacco Mini-grants Applications Sought

Applications for the 2016-17 tobacco and nicotine prevention and control mini-grants currently are being accepted; the deadline to apply is Aug. 15.

The format has changed for this third year of the program, and now five mini-grants of $10,000 each will be awarded to chapters and family medicine residency programs for tobacco and nicotine prevention and control efforts at the state and local levels.

Related AAFP News Coverage
AAFP Tobacco Control Mini-grant Recipients Kick Butts
Funding Helps Spread Anti-Tobacco, Nicotine Messages


Tobacco Control Mini-grants Fund Chapter, Residency Programs