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E.L.S.A.: Eradicate Lung Cancer in South Alabama

Elizabeth is a student working towards a Ph.D. in Epidemiology, with a research focus on lung cancer.

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To stem the tide of smoking and lower the lung cancer burden in southern Alabama, a new and multi-faceted campaign is necessary. Smoking is no longer the only popular tobacco use that can cause lung cancer, as vaping is increasingly popular among teens and young adults while smoking remains prevalent. As such, any new intervention will need to target a wide and varied population, ranging from high school students to low-income individuals as well as the black community. Different members of this target population will not be able to access information about a new intervention in the same ways or in the same places, so multiple dissemination strategies will need to be used. Enter, Eradicate Lung Cancer in South Alabama (E.L.S.A).

E.L.S.A will build upon the existing QuitNow Alabama hotline by adding a text line and Facebook page for the program, making it a more accessible resource for a larger range of patients of all ages, as well as putting it in front of the target audience with increased frequency (through Facebook’s targeted advertisement algorithm). Many smokers may be more comfortable reaching out for help virtually, as it offers some anonymity and represents a much smaller step in the process than, say, going cold turkey. Next, E.L.S.A will implement new anti-smoking campaigns in high schools throughout Mobile and Baldwin Counties, designed to be like but expand on the smoking cessation campaign Not-On-Tobacco, originally developed in the 1990s specifically for teens. This type of campaign will reach current and potential smokers and vapers in high schools throughout both counties, providing them with resources and incentives to quit or say no as well as for further healthy living choices. Similar campaigns, tailored to adults, will be made mandatory for low-income adults on Medicare or Medicaid through the local health department or their primary care provider (while cessation cannot be made mandatory, completing the educational program can be). Finally, the eligible population for the low-dose CT lung cancer screening will be expanded to include those aged 45-85, who currently smoke or who quit in the last 30 years and smoked for the equivalent of 10 pack-years or more (1 pack per day for 10 years, 2 packs per day for 5 years, etc.) - a big change from the current guidelines of those aged 50-80, with 20 pack years or more, who currently smoke or quit in the last 15 years (American Lung Association, 2021). Patients having other imaging done will be able to fill out a questionnaire regarding their smoking status and history and offered the scan the same day if they are eligible. Additionally, primary care providers will be able to order the scan for newly eligible patients during regular office visits and annual wellness exams.

Access Alabama's QuitNow hotline for smoking cessation resources.

Access Alabama's QuitNow hotline for smoking cessation resources.

The main goal of the E.L.S.A program is to reduce the lung cancer burden and mortality rate in south Alabama; this will be achieved by striving for two goals – reducing the number of current smokers and reducing the number of new smokers (I.e., reducing the prevalence of smoking and reducing the incidence of smoking). These are both easily measurable goals, using metrics already regularly followed by both the CDC and the Alabama Department of Public Health. Interventions will take place in multiple locations, as some of the components are virtual. For example, the target audience can access the program from their home, work, school, or anywhere in public via the new text line or Facebook page for QuitNow Alabama. Schools, primary care offices, and health departments are the other main locations for this intervention program. These settings, again, were chosen to reach the wide variety of members of the target audience in places they will already be visiting or which offer a sense of anonymity and comfort – adults must already visit their doctor or the health department for other concerns or wellness visits, patients will already need to have occasional imaging or other testing at facilities which are equipped for the low-dose CT screen, and students must already attend school.

Many, and varied, resources will be needed to effectively implement E.L.S.A. In order to implement any new programs in the county and private schools, the school boards and teachers will need to be educated and on board. Additionally, employees or volunteers will be needed to work on the updated text line as well as build and manage the new Facebook page and ad campaign for QuitNow Alabama. Funding will be the main resource required, in order to pay for the lung cancer screening CTs for the expanded eligible population, for whom insurance may not pay. Ideally, public health educators and community resource volunteers with personal experience quitting tobacco would be beneficial for running the school programs. Local primary care physicians will need to be brought on board and up to speed, as well as provided materials for educating their patients and offering the adult version of the NOT program.

The low-dose lung cancer detection CT is much more accurate than a simple chest x-ray in detecting small malignancies in the lungs.

The low-dose lung cancer detection CT is much more accurate than a simple chest x-ray in detecting small malignancies in the lungs.

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With the basics in place and many resources already available and only in need of expanding, it should only take six months to a year to obtain funding – either through grants or through the Alabama Department of Public Health budget – for E.L.S.A. Before funding is applied for, the program will need to be fully fleshed out and marketed to public health educators and primary care providers in the area – those who will need to sell it to the target population in turn (think multi-level marketing). This will also help gather some of the human resources needed for the eventual implementation. A basic Facebook page for QuitNow Alabama can be started – Facebook is free, and this will get the ball rolling until funding becomes available.

It’s not necessarily a good idea to begin a new school-based intervention in the middle of a school year, and any new program may stand a better chance of school board approval if it is proposed at meetings over the course of the year, to begin at the start of the following school year. Given a planning start date of October 18, 2022, an optimistic date for the school-based intervention implementation is August of 2023 – the start of next school year. A more conservative date is January 2024 – the start of the second semester of the next school year. Once funding is acquired – anywhere between April and October of 2023, a social media manager can be hired for QuitNow Alabama as well as employees to build out and maintain the Facebook page and work the text line. At that time, low-dose lung cancer screening CTs can be offered to the expanded range of patients, marketing and educational materials ordered, and the program put into implementation in full swing across the board. Goals should be measured and monitored annually, and feedback acquired from everyone who completes the program in order to re-evaluate and make changes on an ongoing basis.

References

American Lung Association. (2021). State of Lung Cancer: Alabama. American Lung Association. Retrieved October 18, 2022, from https://www.lung.org/research/state-of-lung-cancer/states/alabama#:~:text=The%20smoking%20rate%20in%20Alabama%20is%2020%25%20and,Black%20Latino%20Asian%20%26%20Pacific%20Islander%20Indigenous%20Peoples

DiClemente, R. J., Salazar, L. F., & Crosby, R. A. (2019). Translating Research to Practice: Putting “What Works” to Work. In Health behavior theory for public health: Principles, foundations, and applications (2nd ed., pp. 216–238). essay, Jones & Bartlett Learning.

This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.

© 2022 Elizabeth Watson

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