African American (AA) women in urban, poverty-stricken neighborhoods have high rates of smoking, difficulties with quitting, and disproportionate tobacco related health disparities. AA women who smoke are twice as likely to die from cardiovascular disease, cerebrovascular disease, and cancer as other ethnic groups. Assisting this underserved population to quit smoking is a national health priority. Recommendations call for more comprehensive, participatory, and multi-level approaches that address social context (i.e., culture, social networks, and neighborhoods) in lifestyle behavioral interventions. The broad, long-term objectives of this research are to optimize smoking cessation outcomes and to reduce associated health disparities in AA women who live in Southeastern US public housing neighborhoods. Using a participatory and social ecological approach, the academic investigators, advisory board, and public housing residents have developed a multi-level intervention (a.k.a. Sister to Sister) that has demonstrated feasibility and potential effectiveness in increasing short-term cessation outcomes. The primary aim of this study is to test the effectiveness of this bundled intervention on long-term (6- and 12-month) cessation outcomes in women in public housing neighborhoods. We will pair-match 14 public housing neighborhoods and randomly assign one neighborhood in each pair (7 per condition) to either a treatment condition (Sister to Sister) or a control condition. We project 203 smokers for treatment and 203 smokers for control, a total of 406 participants (29 per neighborhood), will be required at baseline to detect proposed treatment effects for the primary outcome of smoking cessation. Treatment participants will receive the 24-week, bundled Sister to Sister Intervention consisting of: a) individual level strategies with 1:1 community health worker contact to enhance smoking cessation self-efficacy and spiritual well-being;b) interpersonal level strategies with behavioral counseling in small peer groups to enhance social support;c) neighborhood level strategies with policy and counter-marketing campaigns led by a neighborhood advisory board;and, d) an 8-week supply of nicotine patches and study-specific written cessation materials. Control participants will receive written cessation materials at baseline (Pathways to Freedom) and mailed written cessation materials at weeks 6, 12, and 18. In accordance with community preferences, the control participants will be offered a delayed intervention at the end of the study. Secondary aims are to test the effect of intervention mediators (self-efficacy, spiritual well-being, social support, cessation resources) and moderators (perceived stress, social influences, social ties, neighborhood cohesion, neighborhood smoking prevalence, neighborhood stress) on cessation outcomes. Measures will be assessed at baseline, 6 months, and 12 months. Demonstrating success with this socio-cultural, multi-level approach may lead to wide-scale dissemination and adoption, and decrease disparities of tobacco-related morbidity and mortality in AA females.
African American women in public housing neighborhoods have high rates of smoking and difficulties in quitting. Developing effective socio-culturally relevant health promotion interventions that facilitate positive health behaviors will be vital to the elimination of health disparities in this priority population.
