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. Prior research utilizing conventional outsider driven interventions targeted to the individual have failed to show effectiveness with cessation outcomes in this population. Recommendations call for more comprehensive, participatory, and multi-level approaches that address social context (i.e., culture, social networks, and neighborhoods) in health promotion interventions. The broad, long-term objectives of this research are to optimize smoking cessation outcomes and to reduce associated health disparities in AA women living 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. The primary aim of this study is to test the effectiveness of this 24-week, multi-level intervention (Sister to Sister) on long-term (6- and 12-month) cessation in women in public housing neighborhoods. We will randomly assign 14 public housing neighborhoods (25 female smokers in each neighborhood) to either a treatment condition (Sister to Sister) or a delayed intervention control condition. We project 175 smokers for treatment and 175 smokers for control, a total of 350 participants, will be required at baseline to detect proposed treatment effects for the primary outcome of smoking cessation. Treatment participants will receive the 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 countermarketing 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 a delayed treatment intervention. Secondary aims are to test the effect of intervention mediators (self-efficacy, spiritual well-being, social support, and program utilization) and moderators (perceived stress, social influences, and community cohesion) on cessation. Measures will be assessed at baseline, week 24, and week 52. These study findings will advance scientific knowledge on the effectiveness of integrating community- preferred social context in tobacco cessation interventions. Tobacco use remains the leading cause of preventable death in the US, with widening gaps in health disparities occurring among ethnic minorities. AA women in public housing neighborhoods have high rates of smoking and difficulties in quitting. AA women who smoke are twice as likely to die from heart disease, strokes, and cancer as other ethnic groups. Because traditional smoking cessation programs have had minimal reach or impact with this group, there is a lack of evidence showing us how to help these women quit smoking. 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.
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.
