A randomized controlled trial of a faith-placed, lay health advisor delivered smoking cessation intervention for rural residents

Abstract

IntroductionRural US residents smoke at higher rates than urban or suburban residents. We report results from a community-based smoking cessation intervention in Appalachian Kentucky.Study designSingle-blind, group-randomized trial with outcome measurements at baseline, 17 weeks and 43 weeks.Setting/participantsThis 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.InterventionLocal 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.Main outcome measuresThe primary outcome was self-reported smoking status. Secondary outcomes included Fagerström nicotine dependence, self-efficacy, and decisional balance.ResultsWith 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%.ConclusionsThe Cooper/Clayton Method, delivered in rural Appalachian churches by lay health advisors, has strong potential to reduce smoking rates and improve individuals' health.

Unlocking the potential of population‐based cancer registries

“…53 These data were used to successfully advocate for a public policy requiring all health insurance companies operating in Kentucky to make screening colonoscopy a covered service for age-eligible individuals. [55][56][57][58][59] After this intensive effort, the proportion of the age-eligible population in Kentucky undergoing either colonoscopy or sigmoidoscopy rose from approximately one-third (34.7%) in 1999 to nearly two-thirds (63.7%) in 2008, and Kentucky rose from 49th in CRC screening to 23rd. These interventions included using lay health navigators to reduce cultural barriers and using academic detailing to persuade primary care providers to recommend screening to their age-eligible patients and then schedule CRC screening appointments for these patients.…”

“…These interventions included using lay health navigators to reduce cultural barriers and using academic detailing to persuade primary care providers to recommend screening to their age-eligible patients and then schedule CRC screening appointments for these patients. [55][56][57][58][59] After this intensive effort, the proportion of the age-eligible population in Kentucky undergoing either colonoscopy or sigmoidoscopy rose from approximately one-third (34.7%) in 1999 to nearly two-thirds (63.7%) in 2008, and Kentucky rose from 49th in CRC screening to 23rd. 53 The CRC screening rates in Kentucky have continued to increase.…”

Epidemiology and Implementation of Cancer Prevention in Disparate Populations and Settings

“…25 For example, rural residents are more likely to have higher rates of tobacco use, poor diet, and physical inactivity. [26][27][28][29] They also have lower rates of cancer screening and HPV vaccination. 27,28 Economically, rural residents are more likely to be low income and experience higher poverty levels, which in turn may circumvent needed cancer screenings or treatments due to limited health insurance coverage and financial insecurity.…”

“…35 Given the success of Faith Moves Mountains, the faith-based initiative has been recognized by NCI's Research-Tested Intervention Program and has been expanded to address breast and colon cancer screening, tobacco cessation, healthy living, and diabetes prevention and control among rural Appalachian communities. 29…”

“…This number is partially driven by the 31% of males and 27% of females in Appalachia who consider themselves smokers. 29 Understanding the behavioral and cultural factors that influence why youth begin using tobacco is an important step at devising effective tobacco control interventions. For example, impulsivity, low delay discounting behaviors, and having a parent or friend who smokes are associated with an increased risk of smoking among Appalachian youth.…”