Creating a Tobacco Cessation Program for People with Disabilities: A CBPR Approach Jamie L. Pomeranz, Ph.D., CRC, CLCP Assistant Research Professor Department.

Creating a Tobacco Cessation Program for People with Disabilities: A CBPR Approach

Jamie L. Pomeranz, Ph.D., CRC, CLCPAssistant Research Professor

Department of Behavioral Science and Community Health

University of Florida

PHHP Collaboration PresentationMarch 9, 2011

Acknowledgment

Project Funding

NIH (1R21CA141600-01): NCI Improving Effectiveness of Smoking Cessation Interventions and Programs in Low Income Adult Populations. August 1, 2009-July 31, 2011

Public Health and Health Professions

Collaboration Rehabilitation Counseling Public Health Clinical and Health Psychology Occupational Therapy

Collaborative Research Team

Research Team

Jamie Pomeranz, Ph.D. Principal Investigator

Tracey Barnett, Ph.D. Co-Investigator

Michael Moorhouse, Ph.D. Project Coordinator

William Kennedy CAB Chair

Barbara Curbow, Ph.D. Co-Investigator

Mary Ellen Young, Ph.D. Co-Investigator

Tom Brandon, Ph.D. Co-Investigator

Vani Simmons, Ph.D. Co-Investigator

Paradigm Shift Disability was equivalent to illness, associated with

dependence and lack of productivity (DeJong, 1994; Nosek, 1996; Drum, 2005)

Today, there is increasing public health commitment to addressing the health and wellness of persons with disabilities (Drum, 2005)

2005 Surgeon General’s Call to Action To Improve the Health and Wellness of People with Disabilities

Shift from disability prevention to preventing secondary conditions

Research on Tobacco Use Among

Individuals with Disabilities

Tobacco/Disability Research

Limited empirical research Epidemiological studies

Behavioral Risk Factor Surveillance System (BRFSS)

Health disparities Quality of Life Access to preventative health care

Literature Review Over 50 million Americans experience some form

of disability

Smoking prevalence for people with disabilities is approximately 50% higher than for people without disabilities (Armour et al., 2007)

Adults with disabilities are more likely to have ever smoked, be current smokers, smoke more cigarettes per day, smoke sooner after awaking, and were more likely to be advised by a doctor to quit (Brawarsky et al., 2002)

Smokers with disabilities have reported significantly poorer health-related quality of life when compared to non-smokers with disabilities (Mitra et al., 2004)

Higher prevalence of smoking has been linked to individuals with schizophrenia (Leon et al., 1995; Lohr et al., 1992; Goff et al., 1992)

Direct relationship to barriers to tobacco cessation treatment (individuals with physical and/or mental disabilities) (Brawasky et al., 2002; Friend et al., 2005).

Health professionals have reported They are often preoccupied with the underlying disabling condition Do not view smoking as an important enough issue to address in

lieu of other health issues, Are insufficiently trained to deal with disabled patients, and are not

fully confident in their smoking cessation counseling abilities (Kroll et al., 2006; Friend et al., 2005 Brawasky et al., 2002;; Lezzoni, et al.,

2000;).

Literature Review

Connection Between Low Income and People with Disabilities

Specifically, PWD are more vulnerable to economic hardship than their non-disabled counterparts.

PWD… receive less education, rely more on state/federal assistance, have government issued health insurance, and are more likely to live below the

national poverty line.

Specific Aims

Specific Aim 1. Develop a Community Based Participatory Research (CBPR) tobacco cessation program for PWD. Research Question 1: What components would need to be included

within a CBPR-based tobacco cessation program for PWD? Research Question 2: What are PWD’s perceived barriers to

tobacco cessation treatment?

Specific Aim 2. Implement and test the feasibility of a CBPR Tobacco Cessation Program for PWD Research Question 1: Are traditional outcome measures and intake

assessments appropriate for PWD who complete a CBPR Tobacco Program?

Research Question 2: What are the perceptions of PWD regarding their experience with the CBPR-Based tobacco treatment program?

Center for Independent Living

The CIL, which was founded by PWD. Understand the challenges faced by their consumers. National leader in supporting PWD in their efforts to lead

independent lives. Over 500 locations throughout the United States International locations: Canada, Great Britain, Sweden &

Brazil. Approx 2400 individuals with disabilities receive services

at the CIL in North/Central Florida.

North Central Florida CIL Demographic Data

Community Based Participatory Research

A method whereby the population being studied takes part in all aspects of the research. Adds creditability and rigor to the research.

In other words…..who better to provide insight about people with disabilities, than people with disabilities. PWD will help “drive” the research.

Examples in this process include: Community Advisory Board

Comprised of people with disabilities as well as university researchers

A collaboration to meet research goals (compared to “ivory tower”)

Summary of Methods Convene CAB to review the tobacco cessation curriculum

and offer solutions/feedback regarding other topics.

Interview 10 PWDs about perceived barriers to tobacco cessation treatment and report findings back to CAB.

Report CAB and interview findings to the Expert Panel for curriculum modification.

Report Expert Panel modifications back to the CAB for feedback.

Recruit 24 PWDs to participate in the new tobacco cessation curriculum.

Conduct qualitative interviews with the 24 participants about their experiences.

Administer follow up surveys.

Community Advisory Board Expectations

General Expectations Attend regular CAB meetings Provide feedback regarding research protocol Serve as the “checks and balances” for the

remainder of the research study.

Specific Tasks For CAB Review Quit Now curriculum Discuss qualitative research questions Discuss recruitment strategies Discuss IRB Present findings to Expert Panel

Established Community Advisory Board

CAB Chair – Individual with Spinal Cord Injury

CAB Co-Chair – Individual with Muscular Dystrophy

Member – Individual with Multiple Sclerosis

Member – Individual with Polio Member – Individual with Neurological

Disorder Member – Individual with Mental Health

Condition and Learning Disability Research CAB Liaison – Barbara Curbow,

PhD

Tasks to Date(Specific Aim 1)

Developed CAB Modification of the QSN Curriculum Completed 10 Qualitative

Interviews. Setting up Expert Panel Review

Results

10 Interviews conducted Diverse sample of current smokers

Traumatic Brain Injury COPD Spinal Cord Injury Rheumatoid Arthritis 4 women 6 men

Qualitative DataThemes

Routine Schedule/Culture Peer Pressure Not being educated as to why he/she

should quit smoking. Ritual Low income/low education

population difficult to identify significant barriers to tobacco cessation.

Curriculum Development Facilitator Guide

Disability Education Multiple disabilities within the same

group Disability Etiquette Resources for the facilitator

Curriculum Changes Appropriate language Less education and more motivation. Depiction of people with disabilities

throughout the curriculum E.g. break times, going for a walk.

Less text heavy

Expert Panel

Experienced Tobacco Researchers Experienced Tobacco Clinicians. Motivational Interviewing Expert AHEC Nurse/Director CAB Chairperson

Thank You!

Questions??