Reaching the medically underserved with the AHCPR guideline.

How can we reach underserved populations with the new Agency for Health Care Policy and Research (AHCPR) smoking cessation guideline? What I present are my experiences at Grady Memorial Hospital. Grady is an inner-city hospital in Atlanta, Georgia that serves a poor and medically indigent population. It is the third busiest public hospi tal in the United States, with 700 000 outpatient visits per year. The population served by our health system is about 90% African-American. For my discussion, I will use the population of inner-city African Americans as representative of an underserved group. I believe that many of their concerns and issues are also relevant to other underserved populations. As many of you know, the prevalence of cigarette smoking is falling, both in African-American and in white populations; in fact, the overall adult prevalence in both groups is estimated at approximately 26%.! But these numbers may be misleading. It is quite possible that the medically underserved are also under-represented in national sampling studies. Studies conducted in under served populations in inner-city clinics, hospitals, or public housing developments have found that the prevalence of smoking can climb as high as 50%. At Grady, we found the prevalence to be 42% in men and 24% in women.2 And in Harlem, Resnicow et al found a prevalence of 48% in public housing developments and 48% in the medical setting.3 These sorts of discrepancies can be both prob lematic and instructive.