COMMUNITY

ASSESSMENT
NEEDS
PROJECT
GROUP C

HAZEL, RACHEL, RAHEL, PHIL, & ROSE

DECEMBER 5, 2023
SMOKING CESSATION IN AN UNDERSERVED MINORITY GROUPS
 TARGET POPULATION
• The underserved minority groups refer to
population who has experience healthcare
disparities.
• The population that does not have adequate access
to tobacco cessation program in Washington State.
• This includes people with lower socioeconomic,
low-income, low-education, adults aged 25 to 34,
gender, race, and ethnicity.
 DEMOGRAPHIC POPULATION
§ Age:
- Age 25 to 34 Race:
- Age 35 to 44 § American Indian or Alaskan
- Age 45 to 64 § Native Hawaiian
§ Gender: Female and Male § Black or African American
§ Annual household income- less § Hispanic
than $25,000 § Asian
§ Level of Education (age +25)- High § White
graduate or less
 TOBACCO TREND- WASHINGTON STATE

• Age

• Race
TOBACCO TREND- WASHINGTON STATE

• Annual Household Income

• Level of Education (age 25+)

DEMOGRAPHICS
 PROPOSAL
• Tobacco use, especially cigarette smoking, is a major public health problem in
the United States and globally. Tobacco is the foremost preventable cause of
death in the U.S.
• It is responsible for about half a million tobacco-related deaths and more than
30 percent of all cancer deaths every year.
• Although tobacco use has declined in recent years, the decline in tobacco use
has been unequal across the economic and ethnic sub-populations. It remains
the leading cause of preventable death in Washington state and tobacco-
related health disparities persist.
• In Washington state, there are approximately 13.5 percent of adults still smoke
cigarettes, and more than 20 percent of 10th graders now use e-cigarettes.
 PROPOSAL
• The health impact of tobacco use is not limited to lung cancer as it affects almost all body organs.
• Tobacco use is one of the most significant risk factors in the development and progression
of periodontal disease, and periodontal disease may be related to the prevalence of oral cancer.
- Responsible for about 75% of all oral cavity cancers
- Have 6 times the risk for oral cancer
- Have from 3-17 times for laryngeal cancer
- Smokers are 4 times likely to suffer from periodontal disease than nonsmokers
• Periodontal therapy is less effective in smokers, and more likely to have recurrence after treatment.
SOLUTIONS

Community Engagement Set up an information booth on smoking cessation which will include educational material and interactive games

Educate Educate the patients on the effects of smoking (mental, physical, and oral health risks)

Language Accessibility Pamphlets in different languages

5 A's: Ask, Advise, Assess, Assist, and Arrange

Tailored Interventions 5 R's: Relevance, Risks, Rewards, Roadblocks. Repetition
Personal recommendations are made based on the patients respond (NRT, Rx, counseling, etc)

Collaboration with Collaborate with the dentist/medical physician on prescription options such as bupropion or varenicline
Healthcare Providers

Long-Term Follow-up Continued follow-up on their next appointment to check in on their progress
NEEDS ASSESSMENT
Strength
Cultural Understanding
•Tailoring programs to cultural
preferences enhances effectiveness
Community Support
•Leveraging existing networks enhances
reach and acceptance
Multilingual Resources
•Providing materials in multiple
languages improves accessibility
Customized Interventions
•Targeted approaches address unique
challenges for better outcomes
Weakness
Limited Resouces
•Constraints in funding and manpower
challenge program implementation
Healthcare Disparities
•Existing disparities hinder access to
quality services
Cultural Sensitivity Training
•Lack of cultural competence may result
in inadequate support
Stigma and Mistrust
Opportunities
Policy Advocacy
•Advocating for policies addresses
socioeconomic determinants
Digital Health Interventions
•Technology overcomes geographical
barriers, improving access
Partnerships with Community
Organizations
•Collaborating with local entities
strengthens program impact
Education and Awareness
Campaigns
•Targeted campaigns empower
minorities with information
Threats
Tobacco Industry Marketing
•Aggressive marketing undermines
efforts to reduce smoking rates
Barriers to Healthcare Access
•Persistent barriers limit access to
cessation support
Cultural Resistance to Change
•Norms and beliefs may hinder behavior
change efforts
Mental Health Considerations
•The intersection of mental health and
smoking complicates cessation efforts
STAKEHOLDERS

Anti-Tobacco Business and Community Educational Government

Organizations Employers Organization Institutions Agencies

Healthcare Nonprofit Pharmacutical

Media Outlets Patients/Families
Providers Organization Companies
MISSION STATEMENT

• Our group is working in partnership

with NeighborCare Health, a public
health clinic serving the Seattle area
and Olympia.
INSTRUCTIONAL GOALS

• Provide community with educational resources on tobacco cessation

• Teach community about the effects of tobacco on oral health
• Seek feedback from community about their needs for successful tobacco
cessation
• Improve the overall health status of the community
GOALS
1. EDUCATE PATIENTS ON THE IMPORTANCE OF TOBACCO CESSATION TO PREVENT
PERIODONTAL DISEASE AND OTHER ORAL HEALTH CONDITIONS
2. EDUCATE PATIENTS ON PHARMACOTHERAPIES FOR TOBACCO CESSATION
3. EDUCATE PATIENTS ON NICOTINE REPLACEMENT THERAPY
4. EDUCATE PATIENTS ON BEHAVIORAL THERAPY FOR TOBACCO CESSATION

5. EDUCATE PATIENTS ON EASTERN MEDICINE AS AN OPTION FOR TOBACCO

CESSATION
6. EDUCATE PATIENTS ON REWARDS OF QUITTING TOBACCO USE AND THE IMPORTANCE OF
STAYING TOBACCO-FREE
 SURVEYS
- Goal was to gather information on smoking and tobacco use behaviors
and cessation efforts to better understand this population

- Collected data on: - Provides useful data to shed light on:

- Demographics - Tobacco use patterns
- Tobacco use status - Reliance and addiction
- Age of first tobacco use - Motivation to quit
- Interest in quitting - Challenges faced when trying to quit
- Types of tobacco products used
- Frequency of tobacco use
- Past quit attempts
- Longest time able to abstain from tobacco
- Most recent quit attempt and method
- Medications used to quit
- Triggers for relapse

- Can inform efforts to improve smoking cessation interventions and

approaches

- Will highlight key survey findings in presentation

- Sample may not be representative but offers valuable insights

- Limitations:
- Potential self-report and recall biases
- Tobacco use is a sensitive topic
 ANALYZE / ASSESSMENT

The surveys will be assessed by

Cleaning the data by going through the survey responses to check for any incomplete or nonsensical
answers that need to be removed

Use descriptive stats like frequencies, means, cross tabs to quantify survey answers. Calculate
percentages/ratios. Create charts/graphs

Assess which survey questions were most/least informative by correlating with outcomes

Compare survey responses across subgroups (e.g. age, gender) to uncover group differences

Review and summarize common themes from open-ended questions using content analysis
techniques

Key takeaways by focusing our analysis on findings that relate to original goals or unexpected
outcomes
SURVEY RESULTS Total # of surveys completed – 17

Total # of people who declined to

participate in the survey – 4

Total # of completed surveys

completed tossed out for incomplete
forms – 4

Age of participants average

range from 20 – 72 participant was 38
years of age years old
SURVEY RESULTS CONT.
SURVEY RESULTS CONT.
SURVEY RESULTS CONT.
SURVEY RESULTS CONT.
SURVEY RESULTS CONT.
SURVEY
RESULTS CONT.
• Based upon the questions answered
the data shows that most smokers
started smoking while they were
teenagers.
• The data also shows that all
participants have tried to
quit smoking at some point
• All participants answered with at
least some interest in quitting and if
asked at every dental appointment
they will most likely try to quit
again with more success in the
future.
PAMPHLET

OUTSIDE OF
PAMPHLET
PAMPHLET

INSIDE OF
PAMPHLET

PRINT THESE TO
HAND OUT TO
ANYONE WHO
IS INTERESTED
DIAGNOSIS/DESIGN

Ø Provide clear and easy to understand handouts with diagrams that outline how tobacco use
cause periodontal disease and other health condition including oral cancer.
Ø Stress the importance of tobacco cessation.
Ø Provide appropriate tobacco cessation programs. This may include the tobacco quit
line, pharmacotherapies, nicotine replacement therapy, and behavioral therapy.
Ø Utilize the 5 A's: Ask, Assess, Advise, Assist, and Arrange. If the patient is not ready to quit,
utilize the 5 R's: Relevance, Risks, Rewards, Roadblocks, and Repetition.
NUTRITION
Nicotine is a stimulant that can speed up digestion. The body burns calories
more slowly and the metabolism returns to normal when a patient quit
smoking.

For many patients, fear of gaining weight is a major barrier to quitting

smoking and a major reason for relapse.

While very low-calorie diets and cognitive behavioral therapy may prevent
weight gain without compromising abstinence, advice to regulate weight
by reducing calories may undermine abstinence and is not encouraged.

v Being active every day is a step towards better health and a healthy body
weight for the new tobacco-free patient. Walking, biking, gardening, or
taking the stairs are examples of ways to make physical activity part of
the day.
 THEORY OF HEALTH PROMOTION / BEHAVIOR

Health Belief Model

Concept Intervention Goal
Perceived Susceptibility Establish rapport; assess tobacco use, discuss relationship between Increase awareness and need for behavioral changes, low-income families
tobacco use and periodontal disease. are more likely than higher-income families to face challenges in tobacco
cessation
Perceived Severity Complete the 5 A's and 5 R's; do intral and extra oral exam for any Discuss the consequences and risk of tobacco use in overall health
indication of tobacco use
Perceived Benefits Motivate and encourage patients to participate in smoking cessation Discuss the proper course of action, discuss where, when and how to take
support groups and behavioral therapies action against tobacco use
Perceived Barriers Diagnose and discuss needed smoking cessation programs, identify Identify barriers to care, reduce barriers by offering reassurance, incentives
barriers to care including lack of access and financial obstacles, create a and assistance
treatment plan and make it easy access to the patient
Cues to Action Set up or arrange follow-up care, assess progress every visit, provide Provide pharmacotherapies, nicotine replacement therapy, and a support
patient brochures and guides with information explaining tobacco use system
affecting oral and overall health
Self-Efficacy Educate patients on the importance of smoking cessation, complete and Provide training and guidance in smoking cessation, set progressive goals,
compare periodontal health progress give verbal encouragement and reinforcement
PLAN/DEVELOP

Ø Provide pamphlets in multiple languages based on the population served in the area

Ø Show easy-to-understand pictures and videos that clearly demonstrate how tobacco use cause many
health conditions

Ø Provide a handout that lists tobacco cessation programs

Ø Show clinical examples of oral conditions that caused by tobacco use

Ø Be aware of the common reasons for tobacco use to recommend proper tobacco cessation programs

Ø Be aware of the challenges that underserved minorities face in tobacco cessation interventions
 LESSON PLAN ONE
GENERAL GOAL: EDUCATE PATIENTS ON THE IMPORTANCE OF TOBACCO CESSATION TO PREVENT
PERIODONTAL DISEASE AND OTHER ORAL HEALTH CONDITIONS

Specific Goal: The patient will be able to identify the reasons why tobacco cessation is important in
prevention of many oral health conditions
Hygiene Student Activity: Discuss the relationship tobacco use has with periodontal disease process and
other oral health conditions including oral cancer.

Time Frame: 5 -10min

Learner Activity: Provide patient with pamphlet to take home.

Resources/ Materials: Pictures, and pamphlet on periodontal disease process in result of tobacco use
 LESSON PLAN TWO
GENERAL GOAL: EDUCATE PATIENTS ON PHARMACOTHERAPIES FOR TOBACCO CESSATION

Specific Goal: The patient will be able to identify the most common and effective
medications used for tobacco cessation
Hygiene Student Activity: Discuss the different medications used for tobacco cessation and
assess accessibility
Time Frame: 5 min

Learner Activity: Provide patient with the list of possible pharmacotherapies for tobacco
cessation.
Resources/ Materials: Lists of the different medications used for tobacco cessation.
 LESSON PLAN THREE
GENERAL GOAL: EDUCATE PATIENTS ON NICOTINE REPLACEMENT THERAPY

Specific Goal: The patient will be able to understand the different nicotine replacement
therapy products
Hygiene Student Activity: Discuss the different nicotine replacement therapy products and
how each help with tobacco cessation
Time Frame: 5 min

Learner Activity: Patient will watch educational video on nicotine replacement therapy.

Resources/ Materials: Videos, pictures, and models of nicotine replacement therapy

products
https://youtu.be/CS_IdvUYvGI
 LESSON PLAN FOUR
GENERAL GOAL: EDUCATE PATIENTS ON BEHAVIORAL THERAPY FOR TOBACCO CESSATION

Specific Goal: The patient will be able to understand how behavioral therapy is a great tool
for tobacco cessation
Hygiene Student Activity: Discuss the importance of behavioral therapy in addition to
other tobacco cessation programs
Time Frame: 5 min

Learner Activity: Provide patient on resources such as the guidebook link on behavioral
therapy for tobacco cessation.
Resources/ Materials: Guidebook on how behavioral therapy plays a role in tobacco
cessation
https://www.amazon.com/Cognitive-
Behavioral-Therapy-Smoking-Cessation-
Treatments/dp/0415954630
 LESSON PLAN FIVE
GENERAL GOAL: EDUCATE PATIENTS ON EASTERN MEDICINE AS AN OPTION FOR TOBACCO
CESSATION

Specific Goal: The patient will be able to identify the eastern medicines used for tobacco cessation in
addition to counseling

Hygiene Student Activity: Discuss the different eastern medicines such as auricular acupressure for
tobacco cessation. Acupuncture works by helping to regulate the body’s natural energy flow, to reduce the
cravings of nicotine withdrawal, to calm the mind and ease anxieties, and to strengthen and benefit the
lungs and clear phlegm, tar and nicotine residue out of the lungs.

Time Frame: 5 min

Learner Activity: Patient will be provided with lists of eastern medicines.

Resources/ Materials: Videos and pictures of auricular acupressure to help with tobacco cessation.
 LESSON PLAN SIX
GENERAL GOAL: EDUCATE PATIENTS ON REWARDS OF QUITTING TOBACCO USE AND THE IMPORTANCE OF
STAYING TOBACCO-FREE

Specific Goal: The patient will be able to identify the rewards of quitting tobacco use and the importance of
staying tobacco-free
Hygiene Student Activity: Discuss the positive outcomes of quitting tobacco use by providing the patient
with the list of health rewards and how the crossword puzzle helps keep the mind and hand busy during
craving and stay tobacco-free
Time Frame: 5 min
Learner Activity: Patient will be given a crossword puzzle on quitting tobacco, rewards of quitting tobacco,
and staying tobacco-free
Resources/ Materials: Crossword puzzles on quitting tobacco, rewards of quitting tobacco, and staying
tobacco-free
IMPLEMENT

• Program implementation – We plan to educate the public on how smoking affects your overall and
oral health. In addition, provide smoking cessation material (pamphlets, games, and a poster board)
• For target populations that do not speak English, we created pamphlets (Spanish) that provide the
same information on smoking cessation.
• The presentation took place at the NeighborCare PAC Tower dental clinic, near the front desk, where
patients can easily access our info booth.
• We do not anticipate any cultural barriers, so if we come across any, we can implement the smoking
cessation interview process (5 A's or 5 R's) and use open-ended questions to follow up.
EVALUATION

• Evaluation Outcomes – We expect to see an increase in smoking cessation conversations during

hygiene visits at NeighborCare PAC Tower, specifically (whether it's with the hygienist, dentist,
and/or dental hygiene student). Second, we expect to see an increase in new patients
scheduling with SCC dental hygiene students.
• Evaluation Methods – We plan to evaluate the method progress by monitoring how many new
patients schedule with SCC dental hygiene students and checking in with the West side clinic to
see if there has been an increase in smoking cessation interest/conversation with patients.
 REFERENCES

Boyd, L. D., Mallonee, L. F., Wyche, C. J., & Halaris, J. F. (2020). Chapter 32 – The Patient with Nicotine Use Disorder. Wilkins’
clinical practice of the dental hygienist. Jones & Bartlett Learning.

Hodges, B., & Videto, D. M. (2011). Chapter 10 Program Evaluation: Background and Basics. Assessment and Planning in
Health Programs. Jones & Bartlett Learning.

U.S. Department Of Health And Human Services. (2005). Theory at a Glance – A Guide For Health Promotion
Practice(Second Edition). National Cancer Institute, pg. 13–
20. https://www.sbccimplementationkits.org/demandrmnch/wp-content/uploads/2014/02/Theory-at-a-Glance-A-
Guide-For-Health-Promotion-
Practice.pdf?_gl=1*dxbgk3*_ga*MTU1MTcyNjUxOS4xNjk5NDE4MTg0*_ga_ETKXQ0SWKL*MTY5OTQxODE4My4xLjAu
MTY5OTQxODE4OC4wLjAuMA..&_ga=2.129833740.1852217811.1699418184-1551726519.1699418184

Network--EPH-WTN--4300, W. T. (n.d.). Cannabis and Tobacco Use Data. Washington State Department of Health.
https://doh.wa.gov/data-and-statistical-reports/washington-tracking-network-wtn/cannabis-and-tobacco
WEB LINKS

CDC - People with Low Socioeconomic Status and Commercial Tobacco: Health Disparities and Ways to
Advance Health Equity: https://www.cdc.gov/tobacco/health-equity/low-ses/index.htm

https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/tobacco-use-
and-cessation

https://okhelpline.com/helpline-community/craving-busters/crossword-puzzles/

https://www.scientificamerican.com/article/how-to-reduce-racial-disparities-in-smoking-deaths/

https://www.voicesofyouth.org/blog/minorities-around-world