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Tobacco Cessation Interventions with Low-Income Ohio Appalachian Smokers

July 28, 2011: Cessation: Emerging Interventions and Innovations

Mary Ellen Wewers, Ph.D., M.P.H., Ohio State University

Dr. Wewers began her remarks by providing some background on the U.S. Appalachian Region that includes parts of 12 states and all of West Virginia. Thirty-two counties in Ohio and 20 percent of the states' residents reside in the Appalachian region. The population is characterized by people living in poverty, high rates of unemployment, low-paying jobs, lack of urbanization, deficits in education, and low access to health services. Rates of smoking among adults are very high compared to the national average—34–35 percent of residents are smokers. Until 2006, Ohio did not have a statewide smoke-free law and the tobacco industry aggressively markets smokeless products to young men. It is also a tobacco-growing state.

Two studies were described, both of which were conducted with funding through the National Cancer Institute. The first, an observational study, was conducted to describe the social, behavioral and biological factors related to tobacco use among adult Appalachian women. This study found that current smokers had a higher proportion of risk factors (poor as a child, poor as an adult, pregnant as a teenager or raising children as a single mother) including 50 percent of smokers experiencing four or more of such risk factors.

The second study was an intervention study to test a scientifically-valid tobacco cessation intervention in adult Appalachian women smokers. The intervention included a nurse-managed lay-led health adviser who met face-to-face eight times with each smoker and provided behavioral counseling and eight weeks of a 21 mg nicotine patch. The control group received a letter and educational materials from the clinic's health care practitioner advising them to quit using tobacco and to contact the practitioner for follow-up support. Self-reported and cotinine-validated quit rates were much higher for the intervention group at three and six months but not sustained through 12 months. In addition, those who smoked more cigarettes per day were less likely to quit, as were those with higher rates of depression.

Dr. Wewers concluded her remarks with lessons learned.

  • This was the first trial of evidence-based treatment among Appalachian women.
  • The intervention was successful at three and six months but not sustained through 12 months which may indicate that the intensity and/or duration may need to be extended due to the chronic and recurring nature of tobacco dependence.
  • The women's disadvantaged situations were very evident and depressive symptoms among the population were significant.
  • Cotinine validation was essential.

A second randomized control trial in 12 Ohio Appalachian counties is currently underway to determine the effectiveness of lay-health advisors in implementing the USPHS Clinical Practice Guideline in a public health clinic setting.

Dr. Fiore introduced the next panelist.

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