Health Advocates as a Vehicle to Improve Treatment for Smokers in Public Housing

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DESCRIPTION (provided by applicant): Quitting smoking is the most important step that smokers can take to benefit their health. However, low-income smokers are less successful in quitting than higher-income smokers. If these socioeconomic disparities in smoking and smoking cessation rates persist, low-income smokers will bear an increasingly disparate burden of smoking-related morbidity and mortality. Therefore, interventions to improve the rate of smoking cessation among low-income smokers are urgently needed. Smoking cessation treatment programs such as telephone quitlines and clinic-based programs exist but are underutilized, particularly by low-income smokers. We propose to conduct a group-randomized trial among public housing residents to test whether the use of resident Community Health Advocates with special training in smoking cessation (Tobacco Treatment Advocates (TTAs) can improve (1) utilization of quitlines and clinic-based programs and (2) smoking cessation rates among smokers in public housing. Twenty public housing developments (PHDs) in Boston will be randomly assigned to receive either the TTA intervention or enhanced standard care, with 250 smokers recruited for each condition. The intervention period for each participant will last 6 months, with final outcome assessment 6 months later. At intervention PHDs and TTAs will have 7-9 interactions with smokers to motivate them to use a treatment program, assist in determining which program best meets their needs, proactively connect smokers to programs, address logistical problems and other barriers to program participation, reinforce and augment counseling messages, encourage full utilization of programs including adherence to medication, and provide social support for quitting during and after treatment. Participants at control PHDs will meet once with a TTA who will provide them with culturally-appropriate self-help materials and information on smoking cessation services available through the Quitline and clinic-based programs. The primary outcomes for the study will be (1) utilization of Quitline or clinic-based cessation services (including dose of treatment), and (2) 7-and 30-day biochemically-verified smoking abstinence measured at 3, 7, and 12 months. Data sources for outcomes, as well as hypothesized mediators and moderators, will include quitline and clinic records, TTA records, and questionnaires administered at four time points. A cost-effectiveness evaluation of the cost per additional quit will provide information on the potential for disseminability. PUBLIC HEALTH RELEVANCE: Quitting smoking is the most important step that smokers can take to benefit their health, but low-income smokers are less successful in quitting than higher-income smokers. Interventions to improve the rate of smoking cessation among low-income smokers are urgently needed, or else these smokers will bear an increasingly disparate burden of smoking-related disease and death. Using residents from low-income communities, such as public housing, to help their fellow residents quit smoking may be an effective method to increase the rate of smoking cessation.