Intervention Study to Increase Smoking Cessation Rates Among Public Housing Residents

Health Advocates as a Vehicle to Improve Treatment for Smokers in Public Housing

The purpose of this study is to determine whether public housing residents trained in Tobacco Cessation and Motivational Interviewing Techniques to become Tobacco Treatment Advocates(TTA) will be effective in increasing the quit rate of smokers in Boston Public Housing. The investigators hypothesize that smokers that receive multiple TTA visits will be more likely to (1) use smoking cessation resources and (2) quit compared to smokers who receive a single visit.

The study is a group-randomized trial in which 10 pubic housing developments (PHDs) are randomized to the experimental condition and 10 to the control condition. All smokers who enroll in the study at a particular PHD receive the same intervention. Smokers at control sites receive written materials that offer strategies for quitting and information about availability of treatment programs, as well as a one-time meeting with a Tobacco Treatment Advocate (TTA). The intervention group receives the same written materials but also has much more extensive interactions with a TTA. TTAs provide peer counseling (Peer Counseling is defined as: performance of limited counselor functions, under counselor supervision, by person of similar age,gender, race, ethnicity and/or SES of the counselee) to smokers during in- person Motivational Enhancement meetings (target range 7-9) as well as additional in person and phone contacts, as needed for each participant, over a 6-month period. TTAs receive intensive training in motivational interviewing and smoking cessation counseling deliver the intervention components (counseling activities and provision of environmental supports) in addition to encouraging utilization of smoking cessation treatment programs such as the Smokers' QuitLine (SQL) and clinic-based programs. In order to avoid the potential for contamination due to TTAs interacting with participants at both intervention and control sites, meetings with participants at control sites are conducted by special Control TTAs. Data are collected from study participants at baseline, 3 months, 7 months and 12 months, and also from the SQL and clinics.

Inclusion Criteria:

• Current smoker, defined as having smoked in last 100days
• Housing Sites: Sites are eligible for the study if they have 50+ smokers determined by synthetic estimates based on citywide survey data.
• Age 18-79
• Current everyday or someday smokers
• Planning to quit smoking in 30 days or thinking about quitting in next 6 months,
• Have smoked 100 cigarettes in lifetime
• Speak English or Spanish
• Plan to live in Public Housing for next 12 months
• Able and willing to provide consent

Exclusion Criteria:

• Smokers less than 18 years of age at time of consent.
• Unable to communicate orally in English or Spanish.
• Currently using pharmacological treatment for smoking cessation
• Currently working with the Smokers Quitline or other Community Health Center based cessation program
• Cognitive/ psychiatric conditions that would interfere with ability to understand and participate in the study
• Have been abstinent for 7 or more days.