Legacy reaches low-income families with cessation and secondhand smoke education through partnerships with Head Start and Early Head Start (HS/EHS). We also provide funds to and partner with the Hispanic Association of Colleges and Universities (HACU) and the Inter-Tribal Council of Michigan to support tobacco control efforts on college campuses. In addition, we've recently collaborated with the National Association of Community Health Centers in an effort to address adult tobacco cessation.

Community Health Center Initiative

Community health centers provide vital primary care to 20 million patients in more than 8,000 sites. More than 70 percent of their client base lives in poverty and 36 percent are uninsuredi. Smoking rates are much higher among adults living below the poverty level (29 percent) than among those at or above the poverty level (18 percent)ii.

Legacy and Partnership for Prevention collaborated to produce Help Your Patients Quit Tobacco Use: An Implementation Guide for Community Health Centers.  The guide is intended to help health centers integrate tobacco cessation into their clinical services. It will help health centers to:

  • Begin and sustain efforts to integrate tobacco cessation services into their work by making the case for this service as essential to the mission of providing high-quality, comprehensive care.
  • Think through some of the concrete, day-today issues involved in instituting and maintaining tobacco cessation services.

The guide also features links to resources and highlights the successes of statewide initiatives and health centers around the country.

Between 2008-2011, Legacy and the National Association of Community Health Centers (NACHC) collaborated on a pilot project to enhance the capacity of Federally Qualified Health Centers and State Primary Care Associations to address adult tobacco cessation. Over a three year period, we placed Community HealthCorps members in eight community health centers across the country to enhance cessation efforts. Founded by NACHC, Community HealthCorps is the largest health-focused, national AmeriCorps program that promotes health care for America's underserved, while developing tomorrow's health care workforce.

Below are case studies highlighting the cessation work of two community health center partners.


Head Start and Early Head Start Programs

In the 2010 – 2011 school year, Head Start and Early Head Start (HS/EHS) programs served more than 1,130,500 low-income children up to age five.  Given the high smoking prevalence rates among low-income families and those with less formal education, HS/EHS programs offer an efficient way to reach children and their family members who are vulnerable to tobacco use.

Legacy developed a three pronged strategy to seamlessly integrate tobacco cessation and secondhand smoke work into HS/EHS programs:

1) Systems Change: Modifications in HS/EHS Service Delivery

Legacy helps participating HS/EHS sites modify appropriate existing service delivery protocols to use them to identify, refer, track and support family members who are tobacco users. HS/EHS sites are provided with examples of revised forms that more fully enable staff to determine if any members of a child’s household use tobacco and whether they are ready for cessation services.

2) Staff Training and Development

HS/EHS staff members receive special training that helps enhance the overall delivery of cessation services to families. Training is provided in the following areas:

  • Motivational interviewing;
  • Basics of tobacco addiction and cessation;
  • Brief tobacco intervention skills; and
  • Understanding how to access local and state tobacco cessation services for successful referrals.

3) Establishing Links to other Cessation Providers

Participating HS/EHS sites have the option to refer family and household members to different quit smoking resources, including the state quitline and local cessation service providers. Legacy helps ensure that HS/EHS staff members are well equipped to support family members through the referral process and quit attempt to increase the likelihood of a successful cessation outcome.

Key Resources


College Health Initiative

Our Hispanic/Latino College Health Initiative provided grants to four Hispanic Serving Institutions to implement a web-based survey designed to investigate smoking and tobacco use among Mexican-American, Puerto Rican and Cuban-American college-aged individuals. The initiative will also help increase the capacity for faculty and students to conduct surveillance work. The findings from this project will not only expand knowledge about smoking patterns among Hispanic college students, but they will also aid in the development of effective prevention and intervention programs targeted to college-aged Hispanics and potentially influence campuses to implement smoke-free/tobacco-free policies. 

Legacy’s Tribal College Health Initiative engages American Indian Tribal colleges to implement the American Indian Adult Tobacco Survey (AI-ATS). Project partners recruit and train participating faculty and students from three tribal colleges to conduct, administer and analyze tobacco control data.

The initiative will expand the number of American Indian tribes with tribal-level data assessing beliefs, attitudes and behaviors related to ceremonial tobacco use. This will not only provide tribal specific data, but it will also increase the capacity of tribal colleges and American Indians to effectively conduct, disseminate and use health surveillance and monitoring to advance health-related priorities.

Key Resources



iA Sketch of Community Health Centers:  Chartbook 2013.  National Association of Community Health Centers. 

iiCenters for Disease Control and Prevention. Vital Signs: Current Cigarette Smoking Among Adults Aged ≥18 Years --- United States, 2005--2010, MMWR Morb Mortal Wkly Repo 2011 / 60(35);1207-1212.