The hugely disproportionate burden of death and disease borne by people of color and the poor is not a medical mystery, and its solution does not necessarily require high-tech interventions. Tobacco use is an excellent example because tobacco smoking is a substantial cause of death from five of the seven leading causes of death. Due to concerted public health efforts, smoking prevalence has been reduced by 30% over the last 15 years in the U.S. Yet not all have benefited equally in this great accomplishment. Most of our nation's educated and well-off individuals no longer smoke; the 21% of our adult population who continue to smoke are largely poor, undereducated, and underemployed. ? ? The proposed R24 project """"""""CBPR to Reduce Tobacco Smoking among Residents of a Low-Income Urban Setting"""""""" aims at reducing several health problems caused by or related to tobacco use among people of color and low-SES whites, through partnership with South West Baltimore community that will result in smoking cessation programs that are more effective and more culturally appropriate. Therefore, the specific aims for the proposed project are: (1) through CBPR and other rigorous scientific methods, develop, implement, and evaluate an intervention to reduce tobacco use that will be sensitive to the needs and characteristics of this community and produce a sustained reduction of tobacco smoking among 36% of the participants in the intervention; (2) to investigate specific marketing strategies that may affect consumption patterns; (3) to explore the ecological factors determining tobacco use and quitting behaviors in this community; and, (4) to implement information systems that will help the community track the scope and features of tobacco smoking, major risk and protective factors, in order to identify potential alternatives of action. The project is designed as Community Based Participatory Experimental Research, with mix quantitative and qualitative methods. Intense community involvement and active participation will be the core value of this proposed research. The effectiveness of interventions will be evaluated rigorously using individually tailored treatments with adaptive treatment strategies that use relatively new statistical approaches for effectiveness evaluations in community settings. """"""""Active"""""""" and """"""""passive"""""""" surveillance strategies will be used to analyze the scope, determinants, and dynamics of tobacco use in their community. ? ? ?
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