A systems-based intervention to promote smoking as a vital sign in patients served by community health centers.

The frequency of asking and advising adult patients about tobacco use was measured after an intervention to adopt smoking as a vital sign at 7 community health centers. The intervention consisted of training staff, revising forms and vital sign stamps, and disseminating educational materials. Documentation in medical charts was reviewed for 1,571 randomly sampled patients in 2002 and 2003. The point prevalence (last encounter) and period prevalence (any annual encounter) of asking patients about smoking increased significantly from 2002 to 2003 (59% to 85%, and 71% to 97%, respectively) overall and at each health center. On advising smokers to quit, 4 health centers improved, but the overall point prevalence, 26%, and period prevalence, 46%, were unchanged over time. An intervention using multiple strategies may have contributed to improving the rates of asking but did not have as large or consistent an impact on rates of advising smokers to quit.

A customer service approach to implementing a best practice at community health centers.

It is important that strategies for implementing evidence-based best practices into clinical care are developed and tested. This is particularly true for community health centers (CHCs), which are a primary source of care for low-income patients. This article focuses on a customer service approach to implementing best practices in CHCs. The approach was designed to be responsive to the tremendous demands on and limited resources of CHC staff. The CHC staff were the customers of the project while the project team played a supportive role, acting as a full-service vendor to identify and meet staff needs. Although a tobacco system was the focus of this project, it is applicable to implementing in clinical settings generally, regardless of the particular health topic.

Perspectives from the front lines of tobacco control.

This research is designed to share valuable experiences and transferable principles from program staff of the Legacy/Community Voices initiative who have been involved in planning, implementing, evaluating, and sustaining tobacco control activities in underserved communities. Interviews were conducted with 13 front line staff from 9 sites: Alameda County, California; Detroit, Michigan; El Paso, Texas; Ingham County, Michigan; Miami, Florida; New Mexico; North Carolina; Northern Manhattan; and West Virginia. A model emerged from these interviews that places the life cycle of a program in a central position, with many of the identified themes (working with local champions, obtaining support from multiple partners, increasing organizational capacity) repeated throughout, albeit in different forms at different stages. Reflecting upon wisdom gained and identifying best processes for such work may help ensure that tobacco control programs are developed that are culturally safe and effective in meeting the needs of diverse communities throughout the United States.