Management and Point-of-Care for Tobacco Dependence (PROMPT): a feasibility mixed methods community-based participatory action research project in Ottawa, Canada

Smita Pakhale, Tina Kaur, Catherine Charron, Kelly Florence, Tiffany Rose, Sadia Jama, Robert Boyd, Joanne Haddad, Gonzalo Alvarez, Mark Tyndall

Objective: To determine the feasibility of a Community-Based Participatory Tobacco Dependence Strategy (PROMPT) in the inner city population of Ottawa (Canada).

Design: A feasibility mixed methods prospective cohort study following principles of community-based participatory action research.

Intervention: Recruited 80 people who use drugs, followed them for 6 months while providing access to counselling, nicotine replacement therapy and peer-support in a community setting.

Setting: Community research office in downtown Ottawa, adjacent to low-income housing, shelter services and street-based drug consumption.

Primary outcome: Retention rate at 6-month follow-up.

Secondary outcome: Biochemically validated 7-day point prevalence smoking abstinence at 26 weeks, self-reported abstinence in the past 7 days with exhaled carbon monoxide ≤10 ppm.

Results: The average age of participants was 43.8 years. The 6-month follow-up rate was 42.5%. The mean number of smoking years reported was 27.3 years. The participants were 70% male, 33.7% reported less than a high-school education, 21% identified as indigenous and 43.8% reported an income between US$1000 and US$1999 per month. The baseline mean daily cigarette use was 20.5 and 9.3 cigarettes at study end, with mean reduction of 11.2 cigarettes at 6 months (P=0.0001). There was a considerable reduction in self-reported illicit substance use (18.8%), including a reduction in the opioids heroin (6.3%), fentanyl (2.6%) and Oxycontin (3.8%). The study findings also reveal psycho-socioeconomic benefits such as improved health, return to work and greater community engagement.

Conclusions: The PROMPT project describes socioeconomic variables associated with tobacco and polysubstance use. A programme focused on tobacco dependence, easily accessible in the community and led by community peers with lived experience is feasible to implement and has the potential to support positive life changes. PROMPT’s patient engagement model is an effective harm-reduction strategy for the growing opioid use crisis and can improve the health outcomes of marginalised at-risk populations worldwide.

View the PROMPT paper on BMJ Open


The Ottawa Citizen Engagement and Action Model (OCEAM): A Citizen Engagement Strategy Operationalized Through The Participatory Research in Ottawa Management and Point-of-Care of Tobacco (PROMPT) Study

Smita Pakhale, Tina Kaur, Kelly Florence, Tiffany Rose, Robert Boyd, Joanne Haddad, Donna Pettey, Wendy Muckle and Mark Tyndall

The PROMPT study is a community-based research project designed to understand the factors which affect smoking as well as ways to manage, reduce and quit smoking among people who use drugs in Ottawa.

There is strong medical evidence that smoking tobacco is related to more than two dozen diseases and conditions. Smoking tobacco remains the leading cause of preventable death and has negative health impacts on people of all ages. Although Ottawa has one of the lowest smoking rates in Ontario (12 %), major differences exist, with approximately a 96 % smoking rate among those who use drugs in the city of Ottawa.

To address this inequity, we recruited and trained four community research peers who were representative of the study target population (ex- or currently homeless, insecurely housed or multi-drug users). We designed the ten-step Ottawa Citizen Engagement and Action Model (OCEAM) for the PROMPT study. In this paper we have described this process in a step-by-step fashion, as used in the PROMPT study. The eighty PROMPT participants are being followed for six months and are being provided with free and off-label Nicotine Replacement Therapy (NRT).

View the OCEAM model on BioMed Central


Retail Tobacco Sale in the Community. Should Pharmacies Sell Tobacco Products?

Smita Pakhale, Patricia Folan, Enid Neptune, and David Sachs.

View the article on the Annals of the American Thoracic Society


Tobacco 21: An Important Public Policy to Protect Our Youth

Harold J. Farber, Smita Pakhale, and Enid R. Neptune; on behalf of the American Thoracic Society Tobacco Action Committee

An important approach to reduce youth tobacco use is the adoption of regulations to prohibit tobacco product sale to individuals younger than 21 years, termed Tobacco 21. In the United States, close to 90% of current smokers started smoking before the age of 18 years, and 99% before age 26 years. Earlier age of tobacco use initiation is associated with lower rates of smoking cessation.

Increasing minimum age to purchase has been shown to reduce tobacco product use among youth. The critical determinant is likely the loss of social sources of tobacco products. Enforcement activities are important for age-of-purchase laws to be effective. Raising the minimum legal age to purchase tobacco products to 21 years is highly supported among both the smoking and nonsmoking public.

Tobacco sales to those younger than 21 years account for just 2% of total tobacco sales, yet produce 90% of new smokers. The short-term effect on small business of raising the minimum age to purchase would be minimal. Small businesses will have time to adapt to the decrease in tobacco sales as fewer youth grow up nicotine addicted. Raising the minimum age to purchase of tobacco and nicotine products to 21 years, combined with enforcement of those restrictions, will help protect future generations from a lifetime of tobacco dependence and associated morbidity. These regulations should apply to all tobacco products, including electronic nicotine delivery systems. Respiratory health care providers should educate their local, state, and federal policy makers on the importance of Tobacco 21.

View the article on Annals of the American Thoracic Society


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