# Multi-level interventions for addressing tobacco cessation and SDOH in Community Health Centers (CHCs)

> **NIH NIH U54** · UTAH STATE HIGHER EDUCATION SYSTEM--UNIVERSITY OF UTAH · 2024 · $856,038

## Abstract

PROJECT 1: PROJECT SUMMARY
Tobacco use is the leading cause of death and disability in the United States, and is associated with at least 16
different types of cancers. Though nationwide rates have declined, tobacco use has become concentrated in
populations that have been historically marginalized and plays a critical role in health inequities, accounting
for 34% of the socioeconomic gradient in all-cause mortality and 62% in smoking related diseases, including
cancers of the lip/oral cavity/pharynx, esophagus, larynx, trachea, and lung. These populations also experience
adverse Social Determinants of Health (SDOH), which frequently co-occur with tobacco use, and contribute to
limited access and engagement with evidenced-based interventions (EBIs) for tobacco cessation. Consequently,
addressing SDOH and tobacco use concurrently may address barriers to engaging in EBIs for tobacco cessation
and ultimately reduce the impact of tobacco use among individuals living in poverty. However, the
effectiveness and cost effectiveness of strategies to concurrently increase the reach of EBIs for tobacco
cessation and mitigate the effects of SDOH among individuals living in persistent poverty areas is unknown.
The proposed project, Reach through Equitable Implementation in Utah (REI-UT), is a pragmatic, multilevel
Type III Hybrid Effectiveness-Implementation trial with a 2x2 factorial experimental design. REI-UT will be
conducted with 6 Community Health Center (CHC) systems and 14 primary care clinics across Utah that serve
~1560 patients who use tobacco and live in persistent poverty census tracts. REI-UT utilizes an innovative
bundled approach to address adverse SDOH and tobacco use concurrently, and leverages ubiquitous health
information technology/telehealth for both the evidence-based intervention (EBI) delivery modality (i.e., the
Utah Tobacco Quit Line) and for dissemination and implementation (D&I) strategies. The clinic and patient-
level D&I strategies utilize widely adopted Electronic Health Record (EHR) capabilities, mobile phone—based
conversational agents (CA), and telephone–based patient navigation (PN) approaches to address adverse
SDOH and increase the reach of the Quit Line. Sustainability is enhanced by utilizing an existing, free,
nationally available EBI for tobacco cessation. The aims are to 1) Test the ability of patient level (CA & PN)
dissemination strategies to increase the Reach (primary outcome) of evidence-based tobacco cessation
treatment delivered via the Quit Line among CHC patients who use tobacco and live in persistent poverty
census tracts. Secondary analyses will examine the outcome of Reach of services for SDOH among these
patients, and will evaluate both (1) patient level CA and PN strategies, and (2) clinic level strategy (Ask –
Advise – Connect [AAC] for SDOH) using a pre-post design; 2) Explore contextual factors related to the Reach,
Adoption, Implementation, and potential Maintenance of strategies; and 3) Determine c...

## Key facts

- **NIH application ID:** 10836525
- **Project number:** 5U54CA280812-02
- **Recipient organization:** UTAH STATE HIGHER EDUCATION SYSTEM--UNIVERSITY OF UTAH
- **Principal Investigator:** CHELSEY SCHLECHTER
- **Activity code:** U54 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $856,038
- **Award type:** 5
- **Project period:** 2023-05-03 → 2028-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10836525

## Citation

> US National Institutes of Health, RePORTER application 10836525, Multi-level interventions for addressing tobacco cessation and SDOH in Community Health Centers (CHCs) (5U54CA280812-02). Retrieved via AI Analytics 2026-05-29 from https://api.ai-analytics.org/grant/nih/10836525. Licensed CC0.

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