Tobacco Cessation in Guam‘s Youth:

Utilizing Community Based Engagement and

Partnership

University of Guam/University of Hawaii

Cancer Center Partnership

Neal A. Palafox MD MPH

UH John A. Burns School of Medicine,UHCC

University of Hawaii

1

USAPI Per Capita Total Expenditure on Health (in Purchasing Power Parity (PPP) terms, International $ for FSM, RMI, AS, GU, USA) (in unadjusted USD for CNMI)

$8,467

$531

$506

$260

$380

$440

$140

$414

$1,588

$1,032

$723

$500

$0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 $9,000

USA

WPRO

FSM

Yap

Pohnpei

Kosrae

Chuuk

RMI

Palau

Guam

CNMI

Am Samoa

WHO World Health Statistics 2013 (FM, MH, Palau); WHO Country Profiles 2011 (AS, GU

(2000))

CNMI $39M FY07 budget for CHCC/53,883 popn (2010) in USD not adjusted

4

Community Outreach to Reduce Tobacco Use Disparities Among Pacific Islander Youth in Guam (2009-2012) Effectiveness of a Social Network-based Approach to Reduce Cancer Risk (2013 – present)

Co-leaders:

– Annette M. David, MD, MPH

(UOG)

– Neal Palafox, MD, MPH

(UHCC)

Research team:

– Angelina Mummert, MPA

– Johnny Silbanuez, MPA

Community Outreach

History

– U56 (2005-2009) - Community Coalition (TAG);

what should tobacco research agenda be for

U54?

Advised to focus on youth tobacco use in Guam

– U54 (2009-2014)- Determinants of youth tobacco

use and high rates / problem solving in Guam?

U54 Community Outreach to Reduce Tobacco Use Among PI Youth in Guam

Yr 1: establish advisory tobacco control community advisory group;

and youth coalitions

Yr 2: knowledge, awareness, attitudes, … and practices on tobacco

use; and motivating factors / obstacles to tobacco cessation

Yr 3 mid: develop comprehensive, community-based and culturally

relevant guidelines;

Yr 3, end: disseminate findings & guidelines; implement strategies

for communication and disseminate results.

Implementation:

Milestones: Year 1 Status

Partnership with 2 community

groups comprised of target

youth population

Established: 2 MOUs with:

• Youth for Youth Live Guam

• Chuukese Student Organization

Community advisory group

strategic planning workshop

Accomplished 7 April 2010

Data review Accomplished end of Year 1

Milestones: Year 2 Status

Community research capacity

building workshops

4 Cessation workshops – Feb, Apr, May, Nov 2011

Focus Group Facilitator training – July 2011

CBPR Training workshop - July, 2011

CPBR to delineate correlates

of PI youth tobacco use

Youth focus groups (5) – May/Aug 2010; July/Aug

2011

GIS mapping survey/Photovoice on tobacco

point-of-sale advertising - July 2011

Community research

dissemination

CBPR data analysis workshop - August, 2011

Community Research Summit - August 2011

Effectiveness of Outreach Activities in Target Communities

Policy Outcomes

Program Outcomes

Community Capacity

Community Trust and Development

– CBPA and CBPR

Successes with development and implementation of culturally relevant

strategies Systematic engagement of community to

develop recommendations , build agenda,

and adoption relevant approaches

Community engaged in further action

– community trust and development

– CBPA and CBPR

Youth engaged with research development

and process (photovoice mapping, data analysis, point of

sale analysis)

9

Impact – Policy:

Directly as a result of CBPR of our U54 Community Outreach team, the

GU Legislature issued:

P.L. 30-80 – Increased tobacco taxes on GU, with funds earmarked

for cancer registry (1%) and the Guam Cancer Trust Fund (15%)

P.L. 30-63 – No smoking within 20 feet of entrances/exits

P.L. 31-102 – Prohibiting smoking in a vehicle when a minor is

present

Legislative Bill No. 267-31 (To prohibit the sale of candy cigarettes)

Legislative Resolution No. 211-31 (COR) - Requesting President

Barack Obama to ratify the WHO Framework Convention for Tobacco

Control (FCTC) for the USA.

10

Outcome – Products & Partnership:

Press releases – May, June, August 2011;

Training Report – Tobacco Point-of-sale

Mapping in Guam; Fact Sheets; Brochure; PPT

presentations – Updated Guam BTI Training

PPT, Tobacco and Youth in Guam; Videos -

“The Tobacco Epidemic in Guam,” “Reflections

on CBPR: Youth community researchers,”

“CBPR and Photovoice Findings”; Photovoice

audiovisual presentation – “Tobacco Advertising

on Guam from the Perspective of Youth

Community Researchers”; Guam Community

Stakeholder Forum Report

Noncommunicable Disease (NCD) Consortium;

Guam Comprehensive Cancer Control

Coalition; Legislative Hearings – June 2011

(Cancer Care), October 2011 (Candy

cigarettes); Guam State Epidemiological

Outcomes Workgroup; PEACE Advisory Group

on substance abuse prevention; Guam Medical

Association – 2011 Micronesian Cancer

Conference

Impact – Services:

February 2012 –

DPHSS launched a

telephone quitline

specifically for

Guam youth

12

Outcomes - Community capacity

building:

Capacity building area Number

trained

Number

<25 yrs.

(%)

Chamorro/Mi

cronesian

(%)

Principles and approaches to CBPR 3 1 (33%) 2 (66%)

Brief cessation interventions 73

Photovoice 32 21 (66%) 18 (56%)

Focus group facilitation 9 9 (100%) 8 (89%)

Mapping research 32 21 (66%) 18 (56%)

Research data analysis 29 19 (66%) 22 (76%)

Dissemination and Impact Evaluation of materials and strategies:

Milestones: Year 3 Status

Convene community experts

group to review research

results and finalize locally

relevant TC youth guidelines

Community Stakeholders Forum - August

2012

Guidelines dissemination

Guidelines officially endorsed by:

• Senator Aline Yamashita

• DPHSS

• Tobacco Cessation Program, DMHSA

• Guam Medical Society

• National Association of Social Workers-

Guam Chapter

• Sanctuary, Inc.

• Guam Comprehensive Cancer Control

Coalition

• Guam NCD Consortium

Outcomes – Presentations & Publications:

Presentations: > 16 in Guam; 3 in HI; 4 CONUS

and 12 international

12 publications

15

Outcomes - Technical Assistance:

Finalization of instruments:

Global Youth Tobacco Survey instrument

for Guam DPHSS and Guam Youth Risk

Behavior Survey for Guam DOE

Guam NCD Strategic Plan 2014-2018

Data analysis and technical writing:

2007-2010 Behavioral Risk Factor

Surveillance System (BRFSS) Guam report

Research Opportunities

Series of recommendation from youth

– Evaluate efficacy of recommendations

– Develop culturally and resource relevant relevant

methods for dissemination and wider application

Leverage funds

Formative Research for

– M-health tobacco research (hypothesis driven)

Project 1

Project 2

17

Biospecimen Training:

In 2013, U54 conducted 2 trainings ( 1 each in HI & GU)

using the “Biospecimens and Biobanking” Module from

“Cancer 101: A Cancer Education and Training Program”

designed to: 1) assess the level of readiness of providers

& ancillary staff in cancer institutions to participate in

biospecimen collection efforts, and 2) provide education to

community members about the importance of providing

biospecimens in the advancement of cancer research.

> 60 participants trained

Funded by NCI CRCHD’s Geographical Management of

Cancer Health Disparities Program, Region 6 (FHCRC)

18

Mahalo/Si Yu’us Ma’ase Our youth community partners: Youth for Youth

Live Guam, Chuukese Student Organization

Our community partners

Our research assistants: UOG students Kristine

Borja, Tina Clay, Alyssa Lorzada, Vince

Manibusan, Jason Perez, Katrina Rubio, Johnny

Silbanuez

19