Community-based navigators for tobacco cessation treatment: a proof-of-concept pilot study among low-income smokers.

Arnold H Levinson,Michele Kimminau,Debra Flynn,Patricia Valverde,Karen Albright,Kathleen Garrett,Emily K Burns

doi:10.1186/s12889-015-1962-4

Abstract

BackgroundA majority of continuing smokers in the United States are socioeconomically disadvantaged (SED) adults, who are less likely than others to achieve and maintain abstinence despite comparable quit-attempt rates. A national research initiative seeks effective new strategies for increasing successful smoking cessation outcomes among SED populations. There is evidence that chronic and acute stressors may interfere with SED smokers who try to quit on their own. Patient navigators have been effectively used to improve adherence to chronic disease treatment. We designed and have pilot-tested an innovative, non-clinical community-based intervention – smoking cessation treatment navigators – to determine feasibility (acceptance, adherence, and uncontrolled results) for evaluation by randomized controlled trial (RCT).MethodsThe intervention was developed for smokers among parents and other household members of inner city pre-school for low-income children. Smoking cessation treatment navigators were trained and deployed to help participants choose and adhere to evidence-based cessation treatment (EBCT). Navigators provided empathy, resource-linking, problem-solving, and motivational reinforcement. Measures included rates of study follow-up completion, EBCT utilization, navigation participation, perceived intervention quality, 7-day point abstinence and longest abstinence at three months. Both complete-case and intent-to-treat analyses were performed.ResultsEighty-five percent of study participants (n = 40) completed final data collection. More than half (53 %) enrolled in a telephone quitline and nearly three-fourths (71 %) initiated nicotine replacement therapy. Participants completed a mean 3.4 navigation sessions (mean 30 min duration) and gave the intervention very high quality and satisfaction ratings. Self-reported abstinence was comparable to rates for evidence-based cessation strategies (21 % among study completers, 18 % using intent-to-treat analysis; median 21 days abstinent among relapsers).ConclusionsThe pilot results suggest that smoking cessation treatment navigators are feasible to study in community settings and are well-accepted for increasing use of EBCT among low-income smokers. Randomized controlled trial for efficacy is warranted.

Highlights

A majority of continuing smokers in the United States are socioeconomically disadvantaged (SED) adults, who are less likely than others to achieve and maintain abstinence despite comparable quit-attempt rates
When SED smokers experience acute or chronic stress, they may be less concerned with longterm ill-health effects of smoking than with a perceived need for short-term relief of negative moods and the momentary relaxation they associate with smoking
We developed and pilot-tested a navigator-like intervention to help SED smokers engage with and adhere to evidence-based smoking cessation treatment, using a patient-centered communications style delivered by lay navigators in a community setting serving SED smokers

Summary

Introduction

A majority of continuing smokers in the United States are socioeconomically disadvantaged (SED) adults, who are less likely than others to achieve and maintain abstinence despite comparable quit-attempt rates. There is evidence that chronic and acute stressors may interfere with SED smokers who try to quit on their own. Leading suspected factors include underuse of evidencebased treatment (EBT) [22, 24,25,26,27], and chronic exposure to psychosocial stressors without adequate social support or healthy coping strategies. A fair amount of evidence suggests that social position moderates exposure to acute life stressors, chronic stress, and the acquisition of healthy coping strategies [31,32,33,34]. SED may make it even harder for quitattempters to keep cessation counseling appointments, pay for medication refills, and avoid or recover from lapses to smoking

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Results

Conclusion