Need. Tobacco use is causally linked to 17 different cancers. About 15.7% of Texans smoke cigarettes, the most common form of tobacco use. However, overall population estimates hide subpopulations of Texans with exceedingly high smoking rates. One such group is individuals experiencing homelessness, about 26,000 Texans on any given night. Individuals who are homeless use tobacco at rates as high as 78%. Moreover, tobacco use is not routinely intervened upon in this population, including in shelter or treatment settings, even though a significant proportion of homeless smokers are interested in quitting smoking and receiving help to do so. Although data suggest that they may attempt to quit a...

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Need. Tobacco use is causally linked to 17 different cancers. About 15.7% of Texans smoke cigarettes, the most common form of tobacco use. However, overall population estimates hide subpopulations of Texans with exceedingly high smoking rates. One such group is individuals experiencing homelessness, about 26,000 Texans on any given night. Individuals who are homeless use tobacco at rates as high as 78%. Moreover, tobacco use is not routinely intervened upon in this population, including in shelter or treatment settings, even though a significant proportion of homeless smokers are interested in quitting smoking and receiving help to do so. Although data suggest that they may attempt to quit as often as their domiciled counterparts, their successful quit rates are comparatively very low. Consequently, individuals who are homeless suffer high rates of premature disability and death as related to their tobacco use (e.g., about 33% of their incident cancers were caused by tobacco use, with rates twofold that among domiciled adults). In PP210026, we propose to disseminate and implement Taking Texas Tobacco Free (TTTF), a successful, evidence-based tobacco control intervention for cancer prevention within agencies serving individuals who are homeless and/or vulnerably housed. TTTF has evolved across 4 CPRIT funded awards (PP130032, PP160081, PP170070, PP200051), been implemented through PP170070 in 4 similar homeless-serving agencies - with positive outcomes. Here, we propose to scale-up the program to disseminate to a broader audience across Texas. Responsiveness to CPRIT priorities include: 1) it is an interdisciplinary project; 2) it is a collaborative project between nonprofit entities; 3) it is a project to eliminate tobacco use to reduce new cases and deaths from tobacco-related cancers; and 4) it develops or strengthens the infrastructure supporting the delivery of the most appropriate cancer prevention services (i.e., tobacco use screenings and interventions to an underserved group). Overall Project Strategy. The previously implemented program, TTTF, will be fully scaled-up for application in targeted settings. TTTF implementation in >/=2 homeless-serving agencies will include: 1) the initiation (or refreshing) of tobacco-free workplace policies; 2) education to all employees about the benefits of living tobacco-free; 3) specialized training for providers on treating tobacco use, including embedding Certified Tobacco Treatment Specialist expertise within agencies; 4) the integration of tobacco use assessments/screenings (TUAs) into routine practice; 5) the provision of evidence--based practices for cessation to agency consumers and staff (including Nicotine Replacement Therapies, NRT); and 6) local community outreach/education. TTTF is an empirically-supported intervention that has been successfully implemented within behavioral healthcare facilities across Texas (PP130032, PP160081, PP170070), designed to address similar barriers as seen in homeless-serving agencies. A mixed methods evaluative process will guide program adaptation and implementation in these settings, with an emphasis on capacity building for sustainability beyond the project period. Active and passive dissemination strategies will include a step-by-step implementation/replication guide and toolkit with training materials, tailored materials for passive dissemination, web-based and social media program promotion, hands-on technical assistance, and narratives of best practices. TTTF implementation will include exploration through formative evaluation, organizational preparation, active program implementation, and sustainment/maintenance. Iterative stakeholder feedback will guide implementation. Specific Goals. PP210026 has 3 primary goals: 1) adapt TTTF for dissemination and implementation in targeted settings; 2) execute and evaluate an active implementation within >/=2 agencies serving individuals who are experiencing homelessness to fully inform the dissemination products (e.g., step-by-step implementation/replication guide) to reflect setting-specific considerations, barriers, and solutions; and 3) passively and actively disseminate the adapted TTTF program to interested stakeholders across the state, including non-participating agencies (i.e., those not actively participating in goal 2 above), the public at large, and academic audiences. Significance and Impact. PP210026 will increase the capacity for, and the provision of, evidence-based practices for tobacco control in homeless-serving agencies and thereby address the significantly high tobacco use rates and cancer incidence among this underserved population. Moreover, the dissemination materials and the technical assistance we provide broadly to the public will facilitate agency-led uptake of the program among non-participants in PP210026. Consequently, it will have a tremendous impact in preventing tobacco-related cancers among a highly vulnerable group of Texans.

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