Tobacco use disorder disproportionally impacts under resourced communities including African-Americans and those who are least educated, (Courtesy Photo)

Do you ever wonder how many people in Los Angeles decided that New Year’s Day would be the day of their last cigarette? How many made a resolution to stop smoking and again success eluded them?  To those who tried without success, you are certainly not alone.

Cigarette smoking is known to be the leading preventable cause of disability and death, in the United States and worldwide. While rates of cigarette smoking overall have declined in the United States, equal declines are not being experienced in every community. African American and very often Latino populations in under-resourced communities experience many illnesses such as hypertension, diabetes, stroke, and various types of cancer, at rates greater than the general population.  This is what is called a disparity in the health science research field. Tobacco use disorder disproportionally impacts under resourced communities including African-Americans and those who are least educated, so smoking is a health disparity that may contribute to other health disparities.

Did you know that cigarette smoking and secondhand smoke kill close to one-half million people in the U.S. each year? Even with this knowledge, just wanting to stop lighting up is extremely difficult.  Recent research indicates that approximately 68% of U.S. smokers want to quit and approximately 55% of those smokers attempted to quit.  However, of those, only about 7.5% were actually able to stop smoking.

Why is this so?  What makes it so hard to stop smoking, cut down or to quit using all types of tobacco-related products? The main culprit is nicotine, which is highly addictive.  It causes physical, behavioral, and psychological dependence, and to be successful at stopping or decreasing use, all three of these areas must be addressed.

In response to the large numbers of people with tobacco use disorder served by the Los Angeles County Health System (LACHA), a team of researchers is working within this system to develop and evaluate what might prove to be a best practice to help reduce illness and diseases directly related to tobacco use in L.A. County.

The LACHA was formed by the Board of Supervisors in 2015 to better integrate the Departments of Health Services (DHS), Public Health (DPH) and Mental Health (DMH), with a mission to improve the health and wellness of L.A. County residents through provision of integrated, comprehensive, culturally-appropriate services, programs, and policies that promote healthy people living in healthy communities.

The study team, led by Drs. Theodore Friedman and Brian Hurley, is comprised of a group of clinicians, administrators, researchers, patients and community members. In early 2018, the team began discussing the need for some type of health systems change that could help patients and their medical care teams in their quest to have better health outcomes and help to reduce overall disparities associated with tobacco use. The team decided to look at embedding smoking cessation services into DHS and DMH clinics, beginning with ten clinics scattered around the county.

The team realizes that tobacco use disorder not only causes disease, but it is a disease itself.  As of 2018, tobacco use disorder is fully recognized as a treatable condition by both medical and mental health professionals, and is classified alongside other types of addictive diseases. As with other addictions, supportive services have been shown to be beneficial to recovery efforts.  Consequently, a three-year program that includes various types of medications to help relieve cravings for nicotine and group smoking cessation counseling was developed.  The combination of medications and counseling is more likely to lead to smoking cessation, an idea that will be tested in this study.

Scientific research is being conducted in, with, by, and for communities, with the purpose of achieving a better understanding of how we can improve our health. The patients and community advisory members are full partners in this research, and bring a different perspective to the work making it more ‘patient and community friendly’.

This study is funded by the California Tobacco-Related Disease Research Program and was awarded to Friends Research Institute as the project administrator. In an effort to sustain the successful systems changes, LA County Department of Health Services, Department of Mental Health, and Department of Public Health are supporting the delivery of smoking cessation services for individuals with tobacco use disorder, and underscores the Los Angeles Health Agency’s commitment to improving health of all the individuals Los Angeles County is privileged to serve.

If you smoke cigarettes and receive services from Los Angeles County medical or mental health clinics, you may be eligible to receive services to help you change your smoking behavior.  And if you’re a smoker, your cigarette tax dollars are supporting this work to help people with their tobacco habit. That’s right.  It’s paid for by your tax dollars, so why not learn more and get involved? To do so, call 323-256-3811.