Tobacco use remains a significant public health problem and is increasingly prevalent among vulnerable groups. Appalachian women have a high prevalence of tobacco use and are at increased risk for tobacco-attributable diseases, including cervical cancer. Little is known about the association of social-contextual factors that may modify or mediate the success of a cessation intervention, including the social network of a women smoker. A social network may play a critical role in persistent tobacco use, or conversely, during attempts to quit smoking. These factors may be of particular relevance among disadvantaged smokers, especially in regions where tobacco use is normative. The purposes of this application are to: 1) characterize the social networks of women (never, former and current smokers) in Ohio Appalachian counties;2) determine the association between selected individual, interpersonal, workplace and neighborhood/community-related characteristics and social networks among women in Ohio Appalachian counties;and 3) determine the association between selected individual, interpersonal, workplace and neighborhood/community-related characteristics and smoking status within the social networks among women in Ohio Appalachian counties. A fourth exploratory aim will develop and test the feasibility of a social network-based cessation intervention among Ohio Appalachian women who smoke. Using a cross-sectional design, 400 female residents from four Appalachian health clinics will be randomly selected and invited to participate in a face-to-face interview. Their social network will be characterized and data about individual, interpersonal, workplace and neighborhood/community-related characteristics and smoking status within the social networks will be obtained. Networks will be analyzed for size, including effective size;relationships among members, including maximum numbers;density;redundancy or constraint;percentage of smokers in network;ratio of smokers to non-smokers;and the structural equivalence with the ego (woman participant). Separate regression analyses will be performed to determine the association between individual, interpersonal, workplace and neighborhood/community-related characteristics and each dimension of the social network and smoking status of the participants. In the exploratory aim, focus groups will be conducted to assist in the development of a social network-based cessation intervention. A feasibility test of the intervention will be completed with twelve participants and their social network members.
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