Smoking prevalence among individuals in the criminal justice system is approximately 3- 4 times higher than among individuals outside the criminal justice system and few smoking cessation interventions have targeted this population. One large RCT of female prisoners tested nicotine replacement and 10-session group intervention compared to a wait-list control group and found comparable cessation rates with other community trials. However, smoking cessation interventions have not been conducted with individuals outside penal institutions under community corrections supervision, despite the need to test smoking interventions with low income and other underserved populations. The proposed site, community corrections, has a racially diverse (60% African-American), low income population who do not have access to smoking cessation interventions. This study proposes to examine using bupropion as the platform to examine two different behavioral interventions for smoking cessation with this low income, adult population stratifying for race: a 4 session, intensive counseling intervention compared to an initial session of physician counseling to quit (standard of care). All participants will be treated for 12 weeks with bupropion and abstinence rates will be determine based on cotinine and expired CO for baseline, 4 weekly counseling sessions, weeks 8 and 12 (end-of- treatment). Follow-ups will be at 6, 9 and 12 months after study enrollment. GEE analyses will be used to examine the effect of the intervention over multiple time points and it is believed that African-American smokers will continue to have lower smoking cessation rates compared to Caucasian smokers, although this effect is expected to be attenuated using the motivational interviewing intervention. This study fulfills the RFA mission by examining a novel treatment delivery setting (community corrections) with a low income population who do not have access to smoking cessation treatment using buproprion and comparing two intensities of behavioral therapy. If efficacy is demonstrated, this study would provide a model for integrating smoking cessation treatment in existing programs for community corrections offenders to help provide treatment to a low income and underserved population.
Smoking is now concentrated in low income and other disadvantaged populations such as community corrections. Providing smoking cessation services integrated with community corrections has the potential to provide these services to a low income population who are not able to access community smoking cessation interventions due to lack of insurance and other poverty issues. This project has the potential to reduce the morbidity and mortality associated with smoking with this low income, community corrections population.
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