Examining Smoking Cessation in a Community-Based Versus Clinic-Based Intervention Using Community-Based Participatory Research

Abstract

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.

Systematic review of behavioural smoking cessation interventions for older smokers from deprived backgrounds

“…Eleven studies met the inclusion criteria (figure 1). Nine of the 11 studies were quantitative28–36 and two were mixed-methods design37 38. Three studies were randomised control trials, with the remaining using a range of non-randomised designs.…”

“…Nine studies used a combination of nicotine replacement therapy and behavioural counselling28–30 32–37. One study used only nicotine replacement therapy31 and one used behavioural counselling without nicotine replacement therapy38.…”

“…Ten studies focused on meeting the individual participant’s needs using education and motivational techniques including support and encouragement28–30 32–38. In all 10 studies, the interventions involved used motivational techniques with varying levels of intensity (table 2).…”

“…Nine studies used interventions that were of higher intensity28–30 32 33 35–38. These studies involved incorporating specific action planning, tailored by the participant’s level of quit motivation28, using a combination of manual-based teaching and patient education sessions including relapse prevention modules36, motivational interviewing techniques32, discussions on the benefits and costs of smoking versus cessation33, empowering strategies to enhance self-efficacy38 and cognitive behavioural content35.…”

“…Three studies used financial incentives as part of their intervention32 36 37. A randomised control trial conducted by Lasser et al 32 offered participants $750 for abstinence at 12-month follow-up.…”