Background Tobacco use remains a major public health problem in the U.S. disproportionately affecting underserved communities. The Communities Engaged and Advocating for a Smoke-free Environment (CEASE) initiative is an intervention to address the problem using a community-based participatory research (CBPR) approach. Objective This study compares quit rates in a peer-led community-based intervention with those achieved in a clinical setting. Methods The intervention consisted of three Phases. Phase I (n= 404) was a clinic-based trial comparing two types of counseling. Phase II (n= 398) and Phase III (n=163) interventions were conducted in community venues by trained Peer Motivators. Results Quit rates at 12-week follow-up increased from 9.4% in Phase I (clinic-based) to an average of 23.7% in Phases II and III combined (community-based). The main predictor of smoking cessation was delivery of services in community settings (OR=2.6, 95% CI=, 1.7–4.2) while controlling for possible confounders. Conclusion A community-based approach can significantly guide and improve effectiveness and acceptability of smoking cessation services designed for low-income urban populations. In addition, CBPR can result in better recruitment and retention of the participants.

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Poor persons continue to smoke at high rates and suffer grave health effects. We have been working with our community partners since 2008 to help poor people in the surrounding neighborhoods stop smoking through a multi-phase CBPR intervention known as CEASE. Our study used qualitative methods to identify factors that characterized those who successfully quit smoking (doers) and those who did not (non-doers). Both doers and non-doers identified social pressure as the main reason for starting to smoke, and health as the main motivator for quitting. Although they were similar in many ways, the doers seemed to have more social support for cessation-i.e., more people in their lives who wanted them to quit and whom they wanted to protect from secondhand smoke. The non-doers offered more feedback on how to improve the cessation classes, including making them longer, reducing the class size, adding extra counseling, and using quitting partners. Both doers and non-doers reported increased self-confidence, appreciation for the cessation support they received from CEASE, and a desire that the group classes continue. Cessation is a social event and smokers with more social support appear to be more successful at quitting. Showing interest in and offering social support to poor underserved smokers in their own communities is a powerful way to help them.

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