Project 1: Break Free: Effectiveness of a multi-level smoking cessation program adapted for high-risk women in rural communities

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The prevalence of smoking (25 – 35%) in many underserved Appalachia communities is nearly double the national rate and is a major contributor to the high-risk for cervical cancer in the region. Project 1 – ‘Break Free’ (BF) will implement and test the effectiveness of a healthcare provider- and trained patient navigator-delivered smoking cessation intervention designed to reduce cervical cancer risk within an integrated cervical cancer prevention program. BF is the result of previous work of the team in adapting an evidence-based smoking cessation program to rural populations and will be tested, refined and implemented to achieve high impact and sustainability through billable cost-recovery. BF utilizes a standard format of clinical delivery of Ask, Advise and Connect (AAC) followed by 4 sessions of proactive telephone-based counseling with Nicotine Replacement Therapy support delivered to 600 adult female smokers in primary care practices of 10 non-overlapping health systems in the Appalachian region of four states (KY, OH, VA, WV). BF will be extended to all eligible smokers in the sustainability phase. Delayed versus early intervention health system groups will be compared. Project 1 is closely coordinated with the overall Program Project by providing a key component of an integrated cervical cancer risk reduction/prevention program and its overall outcome and will rely on its shared Cores for harmonization in its implementation, measurement, evaluation and dissemination processes. Project 1 aims are organized along three distinct levels of outcomes: 1) Service outcomes: Determine the effectiveness of a core component of an integrated cervical cancer prevention program designed to help female smokers quit by standardizing clinical practice supports and protocols; 2) Client outcomes: Determine satisfaction with the multilevel intervention; and 3) Implementation outcomes: Test the sustainability of the multi-level intervention via training of providers and staff on counseling and billing for evidence-based smoking cessation services. Successful implementation of BF in the diverse set of rural Appalachian clinics in participating health systems proposed, across 4 states, has the potential for a substantial and sustained impact by improving rural patients’ access to high quality, culturally sensitive, and local evidence-based smoking cessation treatment. If successfully shown to be sustainable at the clinic level, BF could be disseminated widely within rural Appalachia, as well as to healthcare systems in other underserved geographic settings.