The goal of this proposal is to reduce the prevalence of chronic lung diseases and other cigarette related illness in women by implementing a long-term comprehensive community education program to help women quit smoking. Objectives include: motivating women to attempt to quit; providing support for attempts; influencing social norms; and supporting the development of an enduring community commitment to smoking reduction. The program will be directed toward entire populations of women 18-64 years of age living in two counties in Vermont and New Hampshire, particularly those with lower educational and income levels. In each county, a coalition of community organizations will be established to plan and implement the program. Cessation education will be tailored to women's needs and stage of quitting. Program components include frequent, focused cessation messages delivered by a variety of helping professionals; access to self-help cessation materials; opportunities for participation in community cessation programs and events; support systems for women attempting to quit; and other supporting community and media activities. The program will be supported during the 3.5 year initiation phase by a local program staff, a core staff of university-based specialists, and program consultants from the state affiliates of the American Lung Association. During the initiation phase, the coalition will develop an independent identity which will sustain a community focus on cigarette smoking issues. To evaluate the effectiveness of the program, four demographically similar counties have been identified in two states. These four counties have been paired; one member of each pair is located in Vermont, and one is in New Hampshire. One pair of counties has been selected to receive the program; the other pair will not receive the program. Independent random digit telephone surveys of about 6,600 women and 1,000 men will be conducted in all four counties on three occasions during the initial funding period: before the program begins; one year after the program begins; and 3.5 years after the program begins. Sub-samples of those women who report that they are current smokers or have quit will be followed- up after each telephone survey to validate smoking status through a biochemical measure. Mediating variables will also be measured in these surveys. To assess the enduring impact of the program after withdrawal of external support, additional funding will be sought after the initial five year funding period to conduct similar population surveys during the seventh and ninth years.
