Cleveland’s stubbornly high smoking rate is ticking downwards, new data shows – and health officials are looking for ways to keep it moving in that direction.
Case Western Reserve University will use a new $3.3 million grant to work with about 20 local food pantries to connect clients who smoke or vape with a state hotline that helps people quit tobacco.
The effort is in addition to a move by officials to limit the proliferation of smoke shops with recent legislation. The city’s public health director is also pushing to ban flavored tobacco products, but that legislation has stalled.
Researchers hope the food pantry project will reach people who smoke outside a typical health care environment like a doctor’s office or hospital, said Dr. Jin Kim-Mozeleski, a lead researcher on the project and a faculty member at Case Western Reserve School of Medicine.
“We really wanted to kind of bring this to a local setting,” Kim-Mozeleski said. “…How can we increase opportunities for people who are interested in quitting smoking to be exposed to different ways to quit?”
The five-year grant from the National Institutes of Health will help answer that question, in collaboration with the Greater Cleveland Food Bank and the Cleveland Department of Public Health.
The project targets food banks because research has found a significant relationship between food insecurity and cigarette smoking. Kim-Mozeleski said she focuses on this relationship because social needs like food insecurity are “something that we can do something about.”
“If those two areas are correlated with one another, can we address them in tandem for better smoking cessation outcomes?” Kim-Mozeleski said. Cessation means permanently quitting.
Cleveland’s cigarette smoking rates have historically been far higher than the national average. In recent years, those rates have dropped – but the use of cigars is going up, according to the city’s Department of Public Health and the Prevention Research Center for Healthy Neighborhoods at Case Western Reserve.
A new anti-smoking model
The project will use an anti-smoking method called “ask, advise, connect” in local food pantries.
In doctors’ offices, a healthcare professional would ask patients whether or not they smoke and then advise against it if they do.
Then, patients who smoke are asked whether or not they would like resources – such as connection to the state’s quit line. Ohio’s tobacco quit line offers counseling, coaching and free nicotine patches or gum.
If the patient says yes, the healthcare provider sends an electronic alert to the state’s tobacco quit line, which will soon call the patient. That system is far more proactive than former health practices where the patient was advised to call the hotline.
“In the past, it may be like, here’s a pamphlet, call 1-800-QUIT-NOW, or here’s some information that it’s printed out,” said Kim-Mozeleski. “But what this project did was to send the referral directly to the quit line.”
Research shows people who smoke are significantly more likely to enroll in treatment if the quit line calls them instead of the patient calling the quit line.
Bringing anti-smoking resources into Cleveland food pantries
The question for Case Western Reserve researchers is how to implement the model at food pantries.
There are still many outstanding details, Kim-Mozeleski said. For example, who asks the clients coming into the pantry whether they smoke or not – food pantry workers or food pantry volunteers? When should they ask? And what, exactly, should they say to advise against smoking?
“Even that advice, how do you … say it in a way that’s comfortable for the person saying it, non-stigmatizing for the person receiving it and just acceptable in that situation?” Kim-Mozeleski said.
Over the next year, the research team will work with the Greater Cleveland Food Bank, local food pantries and the city’s health department to design an anti-smoking program that is seamless and non-cumbersome. They’re also working to get insight from food pantry volunteers, workers and clients. Kim-Mozeleski and her co-researchers will gather feedback in focus groups and town halls this summer.
By January 2026, researchers hope to roll out the program in 20 food pantries around the city.
Kristen Mikelbank, senior manager of research and program evaluation at the Greater Cleveland Food Bank, said the program is worth trying to improve community members’ health.
“Anything that could be done health-related to kind of improve people’s health outcomes is exciting for us,” Mikelbank said. “Because then that means that maybe they’ll have less health challenges and help them just lead a healthier life.”
Cigarette use dips in Cleveland, but cigar smoking is up
The anti-smoking initiative comes as new data shows cigarette smoking rates dropped by 45% in Cleveland in the last decade. The decline matches national trends.
“A lot of that has to do with the youths not starting cigarette smoking,” Kim-Mozeleski said.
Still, though, the city’s cigarette-smoking rate is double the national rate. And, while cigarette use has ticked down, cigar use in Cleveland ratcheted up, according to data from the Prevention Research Center for Healthy Neighborhoods. Stephanie Pike Moore, an associate professor at Case Western Reserve, is one of the researchers at the center.
“Some concerning trends are specific to cigar products,” Pike Moore said at a press briefing about the recently released data. “…Use of cigar products, particularly among Black or African American residents here in the city of Cleveland, is now at about the same rate as cigarette use. So that’s something that we need to be paying attention to.”
Rates of vaping also increased, but not significantly, according to the Prevention Research Center for Healthy Neighborhoods.