Abstract A013: Increases in provider tobacco cessation training improve non-cigarette tobacco use screening and 5As delivery in rural and medically underserved healthcare settings

Abstract

Medically underserved and rural populations experience high rates of non-cigarette tobacco use (NCTU, e.g., chewing tobacco, vapes) relative to urban populations; this is particularly concerning given NCTU's links to oral and other cancers. This highlights an opportunity to advance cancer prevention by increasing the implementation of evidence-based NCTU interventions in healthcare settings serving these communities. Comprehensive tobacco-free workplace programs (TFWPs) help reduce NCTU by training healthcare providers to use tobacco use assessments (TUAs) and the 5As model (Ask about use, Advise users to quit, Assess willingness to quit, Assist with quitting through counseling and/or medication, and Arrange a follow-up appointment). Evidence examining how changes in provider training impact TUA and 5As utilization for NCTU is limited. Here, we fill that gap by evaluating whether center-level change in tobacco-related training receipt across 17 TFWP-participating healthcare centers moderated the changes over time in TUA and 5As delivery for NCTU. Between 2021 and 2026, 9 medical healthcare centers and 8 substance use treatment centers, together serving >139,000 patients in rural or medically underserved communities in Texas, participated in a comprehensive ∼12-18-month TFWP that included provider training on NCTU screening and intervention. Surveys were administered to providers before (N=391) and after (N=329) TFWP implementation assessing the proportion of new patients receiving TUAs, the proportion of existing patients Asked about NCTU, and among users, the remaining 4As. Centers were categorized into high- and low-change groups by median split of the change in the proportion of providers who had received training. Data were analyzed using an interaction term and post hoc pairwise testing. Center-level increases in tobacco training receipt significantly moderated improvements in administering TUAs (p=0.005), Asking (p=0.021), and Assisting (p<0.001). Compared with low-change centers, high-change centers demonstrated larger improvements in administering TUAs (+20.6% vs. +1.3%), Asking (+20.1% vs. +6.2%), and Assisting (+28.9% vs. +2.5%). Although moderation effects were not significant, pairwise analyses showed significant improvements among high-change centers for Advising (+25.9%; p=0.003) and Assessing (+22.3%; p=0.016). Significant pre-post improvements in Arranging follow-up were also observed in both high-change (+24.3%; p=0.002) and low-change centers (+15.9%; p=0.013). Findings suggest that NCTU patient care in medically underserved healthcare centers is not routinely delivered but can be improved through provider training. Centers where most providers lack recent training on NCTU screening and intervention stand to benefit most from training efforts. Improving care delivery is critical to address tobacco-related disparities in these communities, given increasing NCTU and the popularity of newer products (e.g., nicotine pouches, vapes). Emmanuel Eziakor, Julie Neisler, Ammar D. Siddiqi, Simbiat Eji-Lasisi, Nikhil K. Patel, Maggie Britton, Tzuan A. Chen, Isabel Martinez Leal, Teresa Williams, Kathleen Casey, Lorraine R. Reitzel. Increases in provider tobacco cessation training improve non-cigarette tobacco use screening and 5As delivery in rural and medically underserved healthcare settings [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr A013.