This study investigates the comparative effectiveness of two community interventions aimed at decreasing smoking prevalence in African American populations.
The specific aims are to determine whether an intensive community systems smoking cessation intervention program, designed and administered by the target African American community, will result in a significantly lower prevalence of smoking at 1 and 3 years post- intervention in comparison with a matched reference community receiving a minimal intervention in the form of a standardized informational approach. Targeting of the intensive intervention will be through churches, neighborhood organizations, and the political sector and we will determine its impact on the adoption of self-sustained and self- administered nonsmoking programs and the quit-rate of smokers; anti- smoking advocacy activities by leaders to eliminate public smoking and advertising; the effectiveness of lay health workers as cessation program interventionists; the predictors of smoking cessation in smokers in both the intervention and reference community, including sociodemographic characteristics, co-morbidity, status, exposure to environmental nonsmoking enhancers, social norms, and the processes of change according to the Prochaska model. The intensive intervention, based on behavioral, educational, and process of change principles, develops from a needs assessment of the community, is refined by focus group analyses, and decisions regarding final implementation are through a community-based Steering Community with representation from church, neighborhood, and political leadership, as well as The Johns Hopkins Medical Institutions> Specific smoking cessation strategies will be developed within the context of churches and neighborhood organizations and feature small group and individualized approaches, led by volunteer members of these respective organizations, who are trained and certified in state-of-the-art smoking cessation strategies by expert at Johns Hopkins. Such efforts are reinforced by pastoral and neighborhood organization leadership, support, and recognition, as well as family and peer recognition and reinforcement. Moreover, this effort is further enhanced by environmental support at the community level through combined political and neighborhood advocacy of nonsmoking efforts. Population-based surveys of a random sample of 1,500 individuals from each community at baseline, as well as 1 and 3 Year post-intervention will compare the prevalence of smoking in both communities. This study is significant because it investigates 1) interventions for a broad segment of high risk urban African Americans who would not otherwise be reached; 2) is aimed at community ownership to enhance institutionalization of the program (if found effective); and 3) offers a potential national model for dissemination.
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