Smoking Cessation Program Activities


PUBLIC EDUCATION | PROVIDER EDUCATION | ADVOCACY | POLICY | RESEARCH | DATA COLLECTION |CLINICAL TRIALS DATA

In its deliberations, the panel worked with the overarching goal to create a comprehensive, culturally appropriate anti-tobacco campaign to convey the serious effects of smoking and to discourage smoking among African American adults and youth.

The recommendations also call for supporting NMA physicians by providing them with the appropriate tools and information to encourage smoking cessation among their patients. At the same time, the consensus panel encourages NMA physicians to take leadership roles to advocate for tobacco control nationally and internationally.

Recognizing the paucity of current research on tobacco and African Americans, the consensus panel also proposes that additional resources be devoted to tobacco control research, clinical trials, and dissemination of research.

PUBLIC EDUCATION
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  1. The NMA will continue to develop a culturally competent, comprehensive smoking cessation campaign and will advocate for complementary messages, using a variety of external media (i.e., film, TV, radio, print, medical journals) and internal media (e.g., the Journal of the National Medical Association, NMA Healthy Living magazine, and the NMA website). To disseminate this campaign throughout the community, it will form alliances with groups experienced in marketing to African Americans that also have expertise in carrying health messages to grass-roots organizations (e.g., the American Legacy Foundation, Priority Populations Initiatives, the National Association of African Americans for Positive Imagery, the National Association for the Advancement of Colored People, the Urban League, and other community-based organizations).
  2. The NMA will support effective school-based primary prevention programs aimed at youth, particularly African American youth, forming alliances with organizations aimed at youth, such as the Campaign for Tobacco-Free Kids, the YMCA, the YWCA, the Boys and Girls Clubs, alternative and vocational schools and HBCUs.
  3. Various media outlets or celebrities may be engaged, as part of a multitude of approaches. The NMA will publicize an annual event centered on tobacco control, which would center on the risks of smoking for pregnant women (i.e., birth weight, infant mortality, and postnatal physical and mental health), including the effects of environmental tobacco smoke (ETS) on pediatric diseases such as asthma, middle ear infection, and sudden infant death syndrome.

PROVIDER EDUCATION
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  1. The NMA will develop a distribution plan to disseminate the campaign materials to NMA members. Use of the NMA website and links to other websites to provide more comprehensive information on tobacco control issues to members as well as to consumers will be developed.
  2. The NMA will develop a provider toolkit for members to use in educational efforts as well as for advocacy of tobacco control issues pertinent to African American communities (i.e., smoking cessation, prevention, disparities). The provider toolkit will use the Public Health Service guidelines, modified to be culturally appropriate. These efforts can be expanded through alliances with the National Tobacco Control Program, American Cancer Society, and the like.

ADVOCACY
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  1. The NMA must re-establish a leadership position in setting the tobacco control agenda, in order to decrease the impact of tobacco-related diseases in African American communities. To this end, it should educate African American physicians to advocate and provide leadership for tobacco control. Physicians with expertise in tobacco control should be encouraged to become members of organizations such as the Campaign for Tobacco Free Kids that advocate for smoking cessation among African Americans and become a part of government commissions and committees at federal and state levels. Physicians could also partner with other organizations to advocate for voluntary policies to create smoke-free venues, such as smoke-free college campuses.
  2. Niche markets should be identified that the NMA can address to relay the message of smoking cessation to African Americans. Possible targets include: cigars and “blunts”; smokeless tobacco; promotion of smoke-free environments in institutions such as prisons, mental hospitals, and substance abuse treatment centers; and encouragement of smoking cessation in African Americans, particularly in men and pregnant women.
  3. The NMA should advocate and organize around international tobacco control efforts, especially as they relate to the people of the international African Diaspora. Partnerships with the World Health Organization (WHO) and the Tobacco Control Commission on Africa as well as with international members of NMA and their respective embassies should be considered.
  4. The NMA should review current class-action suits involving tobacco control in African Americans.

POLICY
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  1. Key members should organize around tobacco settlement issues to ensure that funding is equally allocated to all segments of the African American community, according to the impact of tobacco use on morbidity and mortality.
  2. The NMA should identify “best practices” or models of information distribution from the state level to the membership, in order to mobilize NMA members around the tobacco settlement funding process.
  3. A survey of the NMA membership should be implemented to determine their baseline knowledge. The survey will provide an opportunity to educate members about the laws and regulations governing smoking in work sites, public settings, and homes.
  4. The NMA should continue to support all legislation that requires regulation of tobacco and its products by the Food and Drug Administration, with preference given to efforts that oppose the marketing of high-nicotine and menthol products to African Americans.
  5. The NMA should assist in the development and support legislation that increases reimbursement for treatment of tobacco dependence in African Americans, by such methods as nicotine replacement therapies, other medications, and counseling.
  6. The NMA should encourage an ongoing assessment by federal and state agencies of their cultural capacity and infrastructure to support the African American community in this work.

RESEARCH
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  1. The NMA recognizes the paucity of evidence-based outcomes relate to tobacco control in African Americans and supports the following lines of research:
    1. Review of and new research on smoking patterns and the metabolism of nicotine and cotinine in African American versus other ethnicities (i.e., menthol cigarette use in African Americans, cotinine levels and other tobacco metabolites in African Americans, family history and patterns of smoking, etc.).
    2. Dissemination of research information to African American physicians about smoking cessation counseling and treatment patterns as well as resource patterns.
    3. Review of tobacco industry documents targeted at African Americans.
    4. Review and conduct new research in the area of smoking cessation among African Americans (i.e., cultural differences in approaches, what works and why, counseling outcomes, nicotine replacement therapies).
    5. Assess or conduct market research in African American communities.
    6. The effectiveness of federal/state efforts in regards to the elimination of population disparities.
    7. Development, training, and dissemination of tobacco control protocols that are relevant and culturally competent for use in African American communities (e.g., the publication Pathways to Freedom).
  2. The NMA strongly endorses the use of more African American physicians as well as other minority researchers in the development, design, implementation, and evaluation of clinical trials and will serve as a clearinghouse for such cooperative activities. In particular, it should partner with historically black colleges and universities (HBCUs) as well as with minority researchers (as principal investigators).
  3. Panelists urged continued research on relevant topics, including the following:

    1. What are the attributes of individuals who quit smoking without the aid of pharmaceuticals? What are the attributes of individuals who quit with pharmaceuticals? What are the attributes of individuals who fail to quit?
    2. How do we bring about a shift in the treatment of tobacco addiction? The message should be one of “Let me (the physician) help you quit” versus “You should quit and do it by yourself.”
    3. The economic impact of smoking cessation on neonatal units and other facets of the health delivery system?
    4. Other research categories that the NMA and its W. Montague Cobb Institute might want to pursue include neurobiological, behavioral/attitudinal, model prevention/treatment, environmental, and economic.

DATA COLLECTION
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Data indicating increased tobacco-related morbidity and mortality in African Americans are abundant. However, despite the numerous studies documenting the negative outcomes suffered by African Americans and the general disparity in disease outcomes, the panel stated that data collection efforts regarding African-American patients and physicians, including responses to medications, need to be refined. The panel discussed the following:

- Culturally specific data
- Clinical trials data
- Patient data

There is a need for improved understanding of how race and cultural practices, independent of socioeconomic variables, may influence care for tobacco-related diseases and smoking cessation counseling and the use of health services in all African American patient populations. To achieve this goal, there is a need to expand current and design future studies to include adequate sampling of both inner-city and non-inner-city African American patients.

CLINICAL TRIALS DATA
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The panel supports federal initiatives led by the U.S. Food and Drug Administration to increase minority representation in clinical trials. Clinical trials ensure the safety and effectiveness of medications and other cessation therapies in targeted patient populations. Research indicates that race and cultural behaviors may influence a patient’s response to these medications.

The NMA encourages, through its research institute (W. Montague Cobb) and the clinical trials program IMPACT, the increase of minority physician and consumer participation in clinical trials involving tobacco-related disease and smoking cessation therapies.

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