A Trial of Church-Based Smoking Cessation Interventions for Rural African Americans

doi:10.1006/pmed.1996.9988

Preventive Medicine

Volume 26, Issue 1, January 1997, Pages 92-101

https://doi.org/10.1006/pmed.1996.9988 Get rights and content

Abstract

Background.The Alliance of Black Churches Health Project was begun in an effort to address the health problems of the African-American residents of two rural Virginia counties. Smoking cessation was chosen as the principal target behavior in one county. Church coalitions were chosen as the principal organizations through which to implement the interventions.

Method.A smoking cessation program was designed that combined one-on-one counseling with self-help materials and community-wide activities. To provide these services, up to two smoking cessation counselors were trained from participating churches. To evaluate the impact, population-based cohorts of smokers were assembled in each county using a door-to-door survey. Respondents were recontacted after 18 months. Smoking cessation (1-month continuous abstinence), stages of change, and exposure to the interventions were assessed.

Results.The overall smoking prevalence at baseline was 25.8%. At follow-up, the smoking cessation rate in the intervention county was 9.6% and in the control county 5.4% (P= 0.18). Among those attending church once a month or more, the respective quit rates were 10.5% and 5.9% (P= 0.20). There was significantly more progress along the stages of change in the intervention than in the control county. There was also higher awareness of and contact with smoking cessation programs in the former compared with the latter.

Conclusion.Smoking cessation interventions for African Americans can be successfully implemented through a church coalition. The interventions were associated with significant progress along the stages of cessation. Although the quit rate was higher in the intervention community, the difference was not significant.

References (42)

DP Sheridan
Demographic and educational differences in smoking in a tobacco-growing state
Am J Prev Med
(1993)
JB Schorling
The stages of change of rural African American smokers
Am J Prev Med
(1995)
WF Velicer et al.
Distribution of smokers by stage in three representative samples
Prev Med
(1995)
FA Stillman et al.
Heart, body, and soul: a church based smoking-cessation program for urban African American
Prev Med
(1993)
MMWR
(1991)
MMWR
(1993)
MC Fiore
Trends in cigarette smoking in the United States: the changing influence of gender and race
JAMA
(1989)
MC Fiore
Trends in cigarette smoking in the United States—the epidemiology of tobacco use
Med Clin North Am
(1992)
MMWR
(1994)
CR Stotts et al.
Smoking cessation among blacks
J Health Care Poor Underserv
(1991)

JM Royce et al.

Smoking cessation factors among African Americans and whites

Am J Public Health

(1993)

MMWR

(1993)

CT Orleans et al.

Smoking cessation initiatives for black Americans: recommendations for research and intervention

Health Educ Res

(1989)

U.S. Department of Health and Human Services, 1991, Strategies to control tobacco use in the United States: a blueprint...

MMWR

(1991)

SW Headen

Are the correlates of cigarette smoking initiation different for black and white adolescents

Am J Public Health

(1991)

LP Hahn et al.

Cigarette smoking and cessation behaviors among urban blacks and whites

Public Health Rep

(1990)

GC Kabat et al.

Comparison of smoking habits of blacks and whites in a case-control study

Am J Public Health

(1991)

TE Novotny et al.

Smoking by blacks and whites: socioeconomic and demographic differences

Am J Public Health

(1988)

MMWR

(1990)

Cited by (99)

A randomized controlled trial of a faith-placed, lay health advisor delivered smoking cessation intervention for rural residents
2016, Preventive Medicine Reports
Citation Excerpt :
Community-based participatory research (CBPR) efforts in smoking cessation typically target ethnic and racial minorities, (Andrews et al., 2007; Daley et al., 2010; McDonnell et al., 2011; Wu et al., 2009) youth, (Horn et al., 2006; Woodruff et al., 2007) and other marginalized populations experiencing health disparities (Matthews et al., 2013). Smoking cessation studies seldom use CBPR (Nafziger et al., 2001; Schorling et al., 1997). Those that have used CBPR generally have yielded modest positive outcomes.
Rural US residents smoke at higher rates than urban or suburban residents. We report results from a community-based smoking cessation intervention in Appalachian Kentucky.
Single-blind, group-randomized trial with outcome measurements at baseline, 17 weeks and 43 weeks.
This faith-placed CBPR project was located in six counties of rural Appalachian Kentucky. A total of 590 individual participants clustered in 28 churches were enrolled in the study.
Local lay health advisors delivered the 12-week Cooper/Clayton Method to Stop Smoking program, leveraging sociocultural factors to improve the cultural salience of the program for Appalachian smokers. Participants met with an interventionist for one 90 min group session once per week incorporating didactic information, group discussion, and nicotine replacement therapy.
The primary outcome was self-reported smoking status. Secondary outcomes included Fagerström nicotine dependence, self-efficacy, and decisional balance.
With post-intervention data from 92% of participants, those in intervention group churches (N = 383) had 13.6 times higher odds of reporting quitting smoking one month post-intervention than participants in attention control group churches (N = 154, p < 0.0001). In addition, although only 3.2% of attention control group participants reported quitting during the control period, 15.4% of attention control participants reported quitting smoking after receiving the intervention. A significant dose effect of the 12-session Cooper/Clayton Method was detected: for each additional session completed, the odds of quitting smoking increased by 26%.
The Cooper/Clayton Method, delivered in rural Appalachian churches by lay health advisors, has strong potential to reduce smoking rates and improve individuals' health.
Factors associated with seasonal influenza immunization among church-going older African Americans
2014, Vaccine
Citation Excerpt :
Previous studies have shown that people with higher levels of church participation tend to have better health outcomes [19]. Additionally, churches can be important conduits for disseminating health messages and generating strong participation for health screenings, including those for hypertension [20], diabetes and obesity [21], and tobacco addiction and comorbidity reduction [22]. Given that churches may exert considerable influence on attitudes and social norms among older African Americans, this study endeavored to examine how these factors impact influenza immunization coverage among church-going elders.
Churches and faith institutions can frequently influence health behaviors among older African Americans. The church is a centerpiece of spiritual and social life among African American congregants. We explored its influence on influenza immunization coverage during the 2012–2013 influenza season.
A cross-sectional study was conducted among congregation members ages 50–89 years from six churches in the Atlanta region in 2013–2014. We computed descriptive statistics, bivariate associations, and multivariable models to examine factors associated with immunization uptake among this population.
Of 208 study participants, 95 (45.7%) reported receiving the influenza vaccine. Logistic regression showed that increased trust in their healthcare providers’ vaccine recommendations was a positive predictor of vaccination among participants who had not experienced discrimination in a faith-based setting (OR: 14.8 [3.7, 59.8]), but was not associated with vaccination for participants who had experienced such discrimination (OR: 1.5 [0.2, 7.0]). Belief in vaccine-induced influenza illness (OR: 0.1 [0.05, 0.23]) was a negative predictor of influenza vaccination.
Members of this older cohort of African Americans who expressed trust in their healthcare providers’ vaccine recommendations and disbelief in vaccine-induced influenza were more likely to obtain seasonal influenza immunization. They were also more likely to act on their trust of healthcare provider's vaccine recommendations if they did not encounter negative influenza immunization attitudes within the church. Having healthcare providers address negative influenza immunization attitudes and disseminate vaccine information in a culturally appropriate manner within the church has the potential to enhance future uptake of influenza vaccination.
Smoking cessation interventions for ethnic minority groups - A systematic review of adapted interventions
2013, Preventive Medicine
Citation Excerpt :
Smoking is the main preventable risk factor for many of these conditions, in particular, respiratory and cardiovascular diseases, and cancers (Ford et al., 2012). The health consequences of smoking are magnified for certain ethnic minority groups (Centers for Disease Control, Prevention, 2009): African Americans in the United States (US) have, for instance, a significantly higher smoking-attributable mortality and double the years of potential life lost when compared to the White European-origin population (Schorling et al., 1997). Smoking cessation has substantial health benefits (Bala et al., 2008; Department of Health and Human Services, 1990), for example, a two-fold reduction in the risk of lung cancer (McBride et al., 2002), and a 50% reduction of the excess risk for a cardiovascular event within the first two years after stopping smoking (Lightwood and Glantz, 1997).
Existing smoking cessation interventions tend to be under utilized by ethnic minority groups. We sought to identify smoking cessation interventions that have been adapted to meet the needs of African-, Chinese- and South Asian-origin populations, to increase understanding of the approaches used to promote behavior change, to assess their acceptability to the target populations, and to evaluate their effectiveness.
Two reviewers independently searched for, identified, critically appraised and extracted data from studies identified from 11 databases (January 1950–April 2013). Study quality was assessed using validated instruments (EPHPP and STROBE). Adaptations were independently coded using an established typology, and findings descriptively summarized and thematically synthesized.
23 studies described interventions adapted for African-Americans, and five for Chinese-origin populations. No intervention adapted for South-Asian populations was identified. Six studies directly compared a culturally adapted versus a non-adapted intervention. Adapted interventions were more acceptable to ethnic minority groups, but this did not translate into improvements in smoking cessation outcomes.
Given the evidence of greater acceptability of adapted interventions, it may be ethically preferable to use these. There is, however, no clear evidence of the effectiveness of adapted interventions in promoting smoking cessation in ethnic minority groups.
Double sparsity garrotized kernel machine in high-dimensional partially linear model
2024, Communications in Statistics: Simulation and Computation
Smoking Cessation Interventions and Abstinence Outcomes for People Living in Rural, Regional, and Remote Areas of Three High-Income Countries: A Systematic Review
2023, Nicotine and Tobacco Research
Type 2 Diabetes Prediction Using Machine Learning and Validation Using Weka Tool
2023, Lecture Notes in Networks and Systems

View all citing articles on Scopus

^☆: Supported by Grant RO1HL43611 from the National Heart, Lung, and Blood Institute.

^☆☆: D, M, BeckerD, R, HillJ, S, JacksonD, M, LevineF, A, StillmanS, M, Weiss, editors

²: To whom correspondence and reprint requests should be addressed at Box 494, University of Virginia Health Sciences Center, Charlottesville, VA 22908. Fax: (804) 924–1138.

View full text

Regular ArticleA Trial of Church-Based Smoking Cessation Interventions for Rural African Americans☆,☆☆

Abstract

Am J Prev Med

Am J Prev Med

Prev Med

Prev Med

MMWR

MMWR

Trends in cigarette smoking in the United States: the changing influence of gender and race

JAMA

Trends in cigarette smoking in the United States—the epidemiology of tobacco use

Med Clin North Am

MMWR

Smoking cessation among blacks

J Health Care Poor Underserv

Smoking cessation factors among African Americans and whites

Am J Public Health

MMWR

Smoking cessation initiatives for black Americans: recommendations for research and intervention

Health Educ Res

MMWR

Are the correlates of cigarette smoking initiation different for black and white adolescents

Am J Public Health

Cigarette smoking and cessation behaviors among urban blacks and whites

Public Health Rep

Comparison of smoking habits of blacks and whites in a case-control study

Am J Public Health

Smoking by blacks and whites: socioeconomic and demographic differences

Am J Public Health

MMWR

Regular Article
A Trial of Church-Based Smoking Cessation Interventions for Rural African Americans☆,☆☆