This study is designed to provide a comprehensive description of smoking beliefs and behavior among rural blacks, and to test the effectiveness of smoking cessation strategies delivered through black churches. Two demographically similar rural counties in central Virginia will be compared, one intervention and one control site. In each country, two cohorts will be assembled, a random sample of all black smokers (the community cohort), and all members of randomly sampled black churches (the church cohort). The descriptive component of the study will involve eliciting the knowledge, beliefs, attitudes, and behavior concerning smoking from these cohorts. Cardiovascular risk factors, including blood pressure and cholesterol levels, will also be determined in the community cohort. For the experimental component, a variety of interventions which have proven to be efficacious in other settings will be implemented through black churches. These will include fostering a supportive environment, distributing self-help materials, and providing individual support and counselling through the use of peer facilitators. The results of the baseline psychosocial survey will be used to modify these methods for local use. They will then be implemented in a culturally appropriate fashion at the intervention sites. Baseline smoking rates will be determined using the initial surveys in both counties. Smokers will be surveyed again at the end of the interventions and one year later to establish one-year abstinence rates. These will be used as the primary outcome variables for the analysis of effect. The principal effect of the interventions will be measured by comparing smoking abstinence rates between the church cohorts in the intervention and control counties. Due to the extended nature of the social networks associated with the churches, the interventions may also have an effect on individuals not directly exposed, and this will be determined by comparing the outcomes in the community cohorts. Finally, the associations between the baseline psychosocial and physiologic variables, exposure to the interventions, and smoking cessation behavior will also be analyzed, to characterize on a population basis those who are and are not influenced by these church-based programs.
