Background/Purpose: Tobacco use remains a leading preventable cause of disease and death, with persistent disparities among Black/African American individuals, LGBTQ+ individuals, individuals with behavioral or mental health conditions, and individuals receiving healthcare assistance. As Colorado's largest safety-net system, Denver Health serves nearly one in four Denver residents annually. With funding from the Colorado Department of Public Health and Environment's Amendment 35 program, Denver Health partnered with patients and providers to identify barriers and co-design strategies to reduce tobacco treatment disparities among these priority populations.
Methods: We used a participatory mixed-methods design across 12 clinical sites. Data included dot-voting with 275 clinical staff, surveys of 59 patients and 27 providers, four focus groups (n=28), and nine provider interviews. Qualitative data were thematically coded; quantitative data summarized descriptively. Findings were synthesized into candidate interventions, prioritized through clinic engagement, then piloted and integrated into workflows. Evaluation included website analytics, QR-code tracking, EHR-based outreach, and pre/post cessation indicators.
Results: Patients identified stress, withdrawal symptoms, social environments, and low motivation as primary barriers; providers added co-occurring mental health conditions, visit time constraints, and cost. Both groups identified nicotine replacement therapy, pharmacotherapy, and one-on-one counseling as most effective. Qualitative themes emphasized non-judgmental communication, follow-up, and clearer cost information. Over 20 interventions were implemented across five domains: provider and patient education (department lectures, patient stories, formulary tip sheet); patient-facing digital outreach (redesigned Tobacco Cessation website, MyChart campaign, banner, resource link, After-Visit Summary education); reducing stigmatizing language (Words Matter preference list, free-text tracking); clinic-based materials (bilingual posters, Gemba boards); and follow-up workflows (STC and TCC call lists). Monthly website views rose, scheduled cessation appointments increased, and smoking prevalence among priority populations declined.
Implications: Patient-centered, non-judgmental engagement supports cessation. Workflow integration determines uptake. Addressing the structural barriers of cost, access, navigation is essential for equitable outcomes.
Thursday September 24, 2026 11:15am - 11:45am MDT Crestone 1
