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Smoking Cessation Treatment Guides for Low-Income Parents of Head Start Children: Formative Lessons of a Pilot Study

July 28, 2011: Cessation: Emerging Interventions and Innovations

Arnold Levinson, Ph.D., University of Colorado

Dr. Levinson began his remarks by describing the population of low-income smokers and how smoking prevalence is high and the quit rate is low. There is no evidence that this is due to less interest in quitting and low-income smokers have in fact a greater rate of quit attempts. Evidence-based treatment is effective with this population but the use of this treatment is much lower perhaps due to a lack of knowledge about, acceptance of, or access to the available options.

Dr. Levinson continued by describing the intervention that included using smoking cessation treatment “guides” for parents of Head Start children. These lay guides facilitated engagement in treatment, supported adherence to the treatment which included the use of NRT, quitline counseling and a visit to a physician for a prescription if the patient preferred this option. The guides, trained in patient-centered communication, never delivered the treatment, but facilitated the patients’ use of it. The objective of the pilot study, conducted with funding from NCI, was to enroll 30 smokers and evaluate the feasibility of the lay guide approach to treatment. The potential importance of this research is that it can support successful quitting, which in turn increases children’s protection from secondhand smoke exposure. As a group, study participants were in general light but dependent smokers, they were motivated to quit smoking and many had tried evidence-based treatment in their previous quit attempts. For the intervention, the participants met with the guides for a median of three 30-minute sessions. As a result, 50 percent enrolled in the quitline and 61 percent requested NRT. Eighty-four percent of participants made a quit attempt with a median of 25.5 days abstinent during the course of the study. If participants relapsed, they were very motivated to try again.

Dr. Levinson concluded with lessons learned from the pilot study. The use of lay guides for smoking cessation treatment is a feasible approach for low-income Head Start parents and the preschool site is a convenient location for parents to attend sessions since they are there twice a day for drop-off and pick-up of their children. At the same time, significant challenges arise for participants in accessing treatment. These challenges include costs incurred in using valuable cell phone minutes to access quitlines; the lack of continuity in access to NRT (only available to participants for four weeks), and the difficulty in accessing physicians who were knowledgeable in tobacco use cessation. Relapse is a very common occurrence, particularly for people living with acute stress, and therefore cessation guidance must be offered over the long-term, not just one time. Because conditions of low-income life make planning very difficult and unreliable it is important that cessation assistance remains very easy, flexible, and cost-free for these smokers.

Dr. Fiore introduced the next panelist.

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