Scientific Abstract
In California, the Central Valley has one of the state’s highest rates of tobacco product use and among the lowest rates of access to traditional primary care providers. In 2016 California gave pharmacists the authority to prescribe nicotine replacement therapy (NRT) to increase access to cessation; as some of the most accessible healthcare professionals, pharmacists are in a unique position to enhance access. Where pharmacist furnishing of tobacco cessation services have been implemented, successful quit attempts double or triple, however uptake of furnishing by pharmacies in California has been slow. We hypothesize that despite the reliance on pharmacists as primary care providers in the Central Valley region, there is little knowledge of their ability to provide tobacco cessation, and that many pharmacists are not yet accredited to furnish. As a result, we propose to:
Aims
Determine the extent of existing pharmacist furnishing in the Central Valley and identify barriers and facilitators to furnishing. In prior research this team has identified pharmacies furnishing hormonal contraception, naloxone, and pre-exposure prophylaxis for HIV (PrEP) in the SF Bay Area using California State Board of Pharmacy active license data, and successfully interviewed pharmacists at locations that did and did not furnish to identify strategies that have led to successful implementation. We will expand on past work by assessing NRT and Central Valley pharmacies.
Assess cessation motivation and barriers among Central Valley tobacco product users. In combination with NCPC and its community partners, we will leverage existing focus group and survey research to identify cessation goals of tobacco users in the Central Valley that have been excluded from past research and health communication (e.g., Filipino, Hmong, Latinx).
Pilot continuing education targeted to concerns of Central Valley communities and pharmacists directed toward increasing local furnishing. Our partner CSHP develops accredited continuing education (CE) for California pharmacists and pharmacy technicians. Results from previous research on furnishing will be combined with findings from Aims 1 and 2 to pilot and evaluate a 2-hour free online course on NRT furnishing for pharmacists in the Central Valley intended to increase pharmacist-led cessation in local communities.
Tobacco Relatedness
The proposed aims are relevant to multiple TRDRP research priorities and are directly focused on tobacco cessation services. State and local tobacco policy research priorities include “cessation treatment research that enhances healthcare policy and systems change (in this case pharmacist furnishing of tobacco cessation)” through “studies of tobacco treatment in locations such as pharmacies.” Social and behavioral research priorities include “collaborative research partnerships…between health care practitioners (pharmacists) and academic researchers (UCSF, UC Merced) to develop a standard process for addressing tobacco product use that can be employed in clinical settings (continuing education through CSHP).” Cancer prevention priorities include “studies of effective methods for disseminating existing prevention programs into low-income communities (the Central Valley).”
Impact on Ending the Commercial Tobacco Epidemic
Aims 1 and 2 explicitly assess the needs and existing access to resources for cessation in communities with disproportionately high rates of commercial tobacco product use. Aim 3 pilots an intervention to reduce commercial tobacco product use, and associated health risks in these communities. Ending the commercial tobacco epidemic requires, among other changes, that existing users move towards abstinence. The proposed aims:
• move California closer to providing “population-wide comprehensive, barrier-free, and widely promoted cessation support” (Endgame Policy Platform),
• explicitly seek the “development and implementation of culturally targeted tailoring of evidence-based strategies supporting cessation (i.e., counseling + NRT)” (Local Lead Agency Campaign to End Commercial Tobacco), and
• expand “engagement of pharmacists in furnishing cessation medications, especially in rural counties and other areas where few physicians are available” (Achieving Health Equity: Toward a Commercial Tobacco-Free California, 2021-2022)
