A participatory randomized intervention to promote and enhance nicotine dependence treatment in a low-income community using community peer-motivators

Background. Low-income urban residents have higher rates of tobacco smoking and they are less likely to utilize treatment services than the U.S. general population. The Communities Engaged and Advocating for a Smoke-free Environment (CEASE) initiative is a participatory randomized health promotion intervention to enhance smoking cessation services in an inner-city low-income setting. Methods. Peer-motivators, nurses, and physicians provided smoking cessation services at a community clinic as well as other community sites. Participants were randomized into group vs. individual counseling plus smoking cessation medication interventions in a clinic during the first phase. In the second phase participants were randomized into two group counseling plus nicotine replacement therapy with different incentive programs facilitated by community peer-motivators in local community sites (e, g., church, school, etc.). Data for this study were collected and triangulated from the following sources: a cross-sectional household survey (n=1,441); participants in smoking cessation interventions (n~650), street intercept surveys (n~4000); focus group discussions (n~100). Data were analyzed using qualitative and quantitative methodologies. Results. More than half (55%) of the total sample were current smokers. Between 36 to 50 percent of the current smokers had tried to quit smoking without seeking any kind of help in the past year. Peer-motivators facilitated interventions in community sites yielded better outcomes such as more abstinence (40% vs. 10%), higher retention (60% vs. 27%), and less cost (p<0.001). Conclusion. Community participatory approach to rigorous scientific methodology is a challenging and at the same time effective strategy to promote and enhance treatment services among underserved populations.