Tobacco use is strongly linked to coronary heart disease (CHD), the leading cause of death in women. African American women of lower socioeconomic status are known to have high smoking rates, disparities in smoking related diseases, and difficulty with cessation. Despite these inequities, sparse data exist describing effective interventions targeted to this population. Although not evaluated in African American women, research supports that intensive group tobacco cessation interventions produce the highest quit rates (24 - 48 percent) over self help (7 - 11 percent) and brief interventions (13 - 16 percent) with other populations. Social support and informal extended kin network, particularly with lay health advisors (LHA), are beneficial in targeted behavioral interventions to African American women for other risk reduction measures such as breast cancer screening; however this approach has not been effectively evaluated with tobacco cessation. With further exploration and knowledge, the investigator's goal is to develop and implement a nurse/LHA-managed smoking cessation intervention tentatively entitled, Sister To Sister: Helping Low-Income Women Quit Smoking. The proposed intervention will target mediating variables of social support, self-efficacy, and adaptive coping mechanisms utilizing an intensive group intervention managed by a nurse and LHA. A community advisory group consisting of informal and formal community leaders will be formed to assist with the recruitment and retention of LHAs. Community partnership(s) with businesses, health agencies, churches, and other organizations will provide a representative to the advisory group and resources such as physical space and incentives for LHA. A mid-range theory of self care behaviors in low-income African American women will be developed to provide a framework the study, and Prochaska's Transtheoretical Model of Change will be used to guide the development and implementation of the nurse/LHA intervention.
