Achieving equity through championing tobacco cessation – SCLC’s mission 20 years later

I became a primary care physician to take care of people long term. I became a public health researcher to change the narrative of health for our disproportionately impacted populations, firmly believing that health equity is rooted in all our populations thriving. The most rewarding aspects of my career has been gaining an understanding of how tobacco is an equity issue, learning how to treat tobacco use, and teaching others how to champion tobacco cessation in their practice.

As a primary care physician and community-engaged researcher working with people experiencing homelessness, I have met and taken care of many people who smoked. For some tobacco use was passed down generation to generation, and for others, tobacco seemed to ease their anxiety, augment their high from opioids, balance their alcohol use, help them cope with stressors of homelessness, and help them grieve loved ones, while ironically, taking away members of their family.

I have also met people who have tried to quit. I’ve learned the importance of receiving support to quit, an area of healthcare where substantial disparities exist.

I recall one long-term patient whom I met eight years ago, who never expected to quit. About 8 months ago, he came to my clinic and asked me to repeat again what I had said to him for years about the importance of quitting and available treatments. He said he would try them and has been tobacco-free since then after 55 years of smoking over a pack per day. I asked him what inspired him to stop—he said it was time and that I had talked about it enough.

I joined the Smoking Cessation Leadership Center this year because one of its missions is to increase the number of providers, professionals and advocacy organizations, state and federal partners who help individuals who smoke to quit. Because my work, both as a physician and a researcher, is focused on developing interventions to help people stop smoking, SCLC’s mission to champion tobacco cessation resonates with me. The role of a smoking cessation champion is not easy, requiring dogged persistence in the face of ever-changing political and healthcare priorities, constant nurturing to keep the priority standing strong in the public’s, organizations’ and policy makers’ eyes, creativity in enlisting partners who ordinarily would not consider smoking cessation within their purview, and a strong belief that championing will lead to tangible outcomes in increasing cessation and reducing smoking prevalence.

Championing has long been an organizational strategy that the SCLC uses to foster culture change in the behavioral health field, where tobacco use has been deeply entrenched among people living with mental health and substance use disorders. Championing will continue to be one of SCLC’s strategies to eliminate disparities in tobacco cessation among behavioral health populations who are low-income, belong to racial/ethnic and sexual gender minorities, or have experienced homelessness or criminal legal systems. As we hone our strategies, our focus will be rooted in equity through (a) ensuring that champions are representative of people who smoke, (b) developing cessation resources that reflect the various narratives of why people smoke, and (c) eliminating barriers in accessing tobacco treatment for disproportionately impacted populations. While championing will remain one of our key strategies, we will invest equally in efforts to evaluate the process by which champions effect change at the system and facility level or individual and provider levels. I am a proud member of the SCLC, leading its efforts with you, our partners, to address one of the oldest and most deeply entrenched public health challenges of our time, and one that requires renewed vigor and championing to eliminate tobacco-related disparities.