在服务于德克萨斯州农村和医疗资源匮乏地区的医疗中心实施无烟工作场所计划后，医务人员开展香烟吸烟干预以预防癌症的变化

Cigarette smoking is elevated in rural and medically underserved areas of the US, contributing to greater tobacco-related cancer morbidity and mortality among residents relative to their urban counterparts. Consequently, there is an opportunity for cancer prevention via use of evidence-based interventions for cigarette smoking in settings where rural and medically underserved adults receive care. The implementation of tobacco-free workplace programs in urban healthcare centers has improved providers' intervention delivery for cigarette use; however, evidence regarding their effectiveness in centers serving rural and medically underserved populations is limited and cannot be assumed, given potentially unique barriers to program adoption. This work seeks to redress this gap by examining changes in providers' delivery of the 5As, an evidence-based intervention for cigarette use, from pre- to post-implementation of a tobacco-free workplace program in centers serving these areas. Healthcare centers (N=9 centers with 17 clinics), together serving 79,266 unique patients annually across 81 rural/partially rural counties and 63 counties with medically underserved areas in Texas, implemented a multi-component tobacco-free workplace program between 2021 and 2025. The program included provider training on evidence-based strategies to address patients' cigarette use with an emphasis on the 5As: A sk about patients' cigarette use, A dvise them to quit, A ssess their interest in quitting, A ssist them to quit, and A rrange a follow-up meeting to support the quit attempt. Providers completed an anonymous e-survey before (N=184) and after (N=126) program implementation, reporting their use of the 5As in the past month. Linear mixed models were used to assess differences between pre- and post-implementation, accounting for nesting of healthcare providers within center. Providers demonstrated clinically meaningful improvements in cigarette intervention provision. From pre- to post-implementation, providers A sked a greater proportion of patients about their cigarette use (57.96% to 72.17%; p=0.08). For patients who smoked, they were significantly more likely to A dvise them to quit (45.40% to 68.64%; p=0.01), A ssess their interest in quitting (38.86% to 63.44%; p=0.01), A ssist in a quit attempt (22.97% to 50.60%; p<0.01), and A rrange a follow-up (17.76% to 39.84%; p<0.01). Results support the promise of tobacco-free workplace programs to address tobacco-related cancer disparities in rural and medically underserved areas by improving providers' use of evidence-based cigarette screening and intervention practices. Future work should examine implementation strategies that support the long-term sustainability of such interventions in this setting.