Grant will expand former smoker-led intervention program

August 13, 2009

AUGUSTA, Ga. - Researchers are helping women who live in public housing in Georgia and South Carolina stop smoking through a proven former smoker-led intervention program.

With $3.1 million in funding from the National Heart, Lung and Blood Institute, Drs. Martha Tingen, a nurse researcher at the Medical College of Georgia's Georgia Prevention Institute, and Jeanette Andrews, associate dean for research and evaluation and director of the Center for Community Health Partnerships at the Medical University of South Carolina, will expand the Sister to Sister program to women in public housing units in Augusta and Charleston, S.C. Dr. Andrews, the grant's principal investigator, developed and tested the program while she was a faculty member in the MCG School of Nursing.

Sister to Sister utilizes help from former smokers from the community, a nicotine patch and group support to help the women kick the habit.

"The program works because it is a multi-level approach," Dr. Andrews says. "We start at the neighborhood level by getting buy-in from the tenants. Then, at the peer-group level, we have the women who want to quit work in groups with a cessation specialist and provide them with the patch. Finally, at the individual interaction level, women work one-on-one with a community health worker."

The program helped nearly 50 percent of women smokers in an Augusta public housing unit quit smoking by the end of a six-week program in 2006. By comparison, less than 8 percent of women in a comparison group without peer and individual support kicked the habit, says Dr. Andrews.

Six months after they quit, 27.5 percent of the women in the treatment neighborhood hadn't resumed smoking. In the comparison group, only 5.7 percent were still smoke-free.

Over the next four years, researchers will expand the study to include 406 women in 16 public housing units - nine in Augusta and seven in Charleston. Half of the women will be part of a treatment group, receiving the nicotine patch and peer and individual support, and the other half will be part of a control group, receiving information on how to quit smoking. Once the study is complete, however, the control group will also receive the patch and have access to peer and individual support.

After six months of the intervention program, participants will be asked to self-report whether they quit smoking. Researchers will also measure levels of salivary cotinine, a metabolized version of nicotine and indicator of smoking, and carbon monoxide in the blood.

"It's important to have the biological validation," says Dr. Tingen.

The program was named Sister to Sister because women were encouraged to quit with other female relatives and quickly formed a sisterhood with each other.

"This is a community-based study," Dr. Andrews says. "We believe that it works because it was developed with input from the women who actually went through the program."

"It was important in developing the materials, for instance, that we use illustrative pictures that women in public housing could relate to," Dr. Tingen adds. "It was important to them to have spiritual themes too. Everything about the program is specifically tailored to what they wanted."

Women in public housing are an important target group because they report higher rates of smoking than women in the general population and they were interested in quitting smoking, according to Dr. Andrews.

"African-American women in public housing communities report a smoking prevalence of 40 percent, with at least two-thirds of households having at least one smoker in the residence," she says. An estimated 40-60 percent of African-Americans in public housing smoke, compared to 20-22 percent in the general population, she says.

"It's important for them to know that we have a long term commitment to the community and their health," she says. "Our experience has shown that empowering them is the key. Women who complete the program often realize they can quit smoking and they feel empowered to make other positive changes in their lives."

Medical College of Georgia at Augusta University

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