Background and challenges to implementation:
The University of Miami (UM) has been working on a State Funded Tobacco cessation program since 10 years conducting free in person cessation group counseling in South Florida from Miami to Key West in a very unique and diverse population ethnically as well as socioeconomic profiles from poorest of the poor and richer to the richest. Homeless and LGBT are the other special populations with a high prevalence of tobacco use.

Intervention or response:
On one hand we deal with cultural diversity like Spanish, Haitian and African American population and on the other hand dealing with the highest tobacco user populations like homeless shelters, prison work release rehabilitation centers, LGBT community centers and HIV clinics. Challenges faced were: - Trust - Safe spaces - Staff and patient turnover - Inability to contact participants before or after program Healthcare provider misconceptions and apathy - "tobacco users don't want to quit"

Results and lessons learnt:
UM tobacco cessation program have been able to take many challenges and have achieved a high quit rate between 46-49 % with a highly addictive population. Some of the lessons learned are: Administration support is necessary Finding a champion On-going communication with facility staff - Staff education dispels myths - Offering recurring groups - Consistent presence increases trust and encourages culture change - Convenience/flexibility Offer groups during high traffic times - Allocate extra time on-site - Train facility staff to do groups - Include as part of position description and annual evaluations - Utilize community partnerships/collaborations - Can provide services not offered by TFF/AHEC, e.g. transportation - Highlight program benefits to facilities

Conclusions and key recommendations:
Tobacco is the most addictive substance in the Universe and quitting is very difficult but following cessation program features are essential: - Persistence - Roll with resistance - Adapt to meet needs/restrictions - Understand your population and the unique challenges/barriers they experience