Community Intervention Trial For Smoking Cessation Research Articles

Reaching toward and beyond the year 2000 goals for cigarette smoking. Research and public health priorities.

The 1980s witnessed decreases in adult smoking prevalence in the face of increasing morbidity and mortality from past and current tobacco use. To facilitate even greater cessation activity, innovative research continues to be conducted on methods of improving intensive, individual approaches to smoking cessation, particularly through pharmacologic intervention. However, the major thrust in this country today is toward broad, systemic, public health campaigns, targeting selected high risk groups and the general public. Vulnerable populations continue to include various ethnic groups, especially those with unusually low or high prevalence, women, persons with smoking-related diseases, and heavy smokers. Self-help methods, physician advice, work site and community based interventions, and antismoking coalitions have been in the forefront. Methodologic and intervention studies are needed, concurrent with ongoing large scale public health efforts. What efforts in research and in the public arena are requisite to reach the year 2000 goals for tobacco use? Prevention remains the number one priority. Bringing about a substantial decline in teenage smoking will require the combination of school based programs, environmental and advertising restrictions, and societal revision of norms toward the relative dangers of smoking and drug use in adolescence. Research is needed to define the optimal combinations of such interventions with booster components to sustain effects. Public health efforts, symbolized by the Community Intervention Trial for Smoking Cessation (COMMIT) and the American Stop Smoking Intervention Study (ASSIST) programs, must be combined with stronger advocacy, taxation, antismoking policy formation and implementation to realize a smoke free society.

Smoking cessation factors among African Americans and whites. COMMIT Research Group.

This study was undertaken to explore smoking patterns and attitudes that influence smoking cessation and relapse among African Americans. Baseline data from eight Community Intervention Trial for Smoking Cessation (COMMIT) sites were analyzed. Compared with Whites, African Americans who smoke less than 25 cigarettes per day were 1.6 times more likely to smoke within 10 minutes of awakening (a behavioral indicator of nicotine dependence), adjusting for education, age, and gender (OR = 1.2 for heavier smokers). African Americans reported a stronger desire to quit smoking and reported serious quit attempts in the past year. African Americans favored tobacco restrictions (they were 1.8 times more likely than Whites to view smoking as a serious community problem, 1.7 times more likely to favor restrictions on cigarette vending machines, and 2.1 times more likely to prohibit smoking in their car). African Americans were lighter/moderate, menthol smokers. African Americans find smoking socially unacceptable and are strongly motivated to quit, but their "wake-up" smoking may indicate high nicotine dependence, making abstinence difficult even for lighter smokers.

Comparison of the Cigarette Brand Preferences of Adult and Teenaged Smokers—United States, 1989, and 10 US Communities, 1988 and 1990

Tobacco use is the single most preventable cause of death in the United States (1). Approximately three fourths of adult regular smokers tried their first cigarette before the age of 18 years (National Institute on Drug Abuse [NIDA], 1988 NIDA Household Survey, unpublished data); about half had become regular smokers before their 18th birthday (2). Knowing what brands young smokers prefer may suggest what encourages them to smoke and may suggest smoking-prevention or smoking-cessation strategies (3-5). To determine brand preferences of smokers, data were reviewed from CDC's National Center for Health Statistics' 1989 Teenage Attitudes and Practices Survey (TAPS) and the National Cancer Institute surveys of adults in 1988 and 9th-grade students in 1990 in 10 U.S. communities* participating in the Community Intervention Trial for Smoking Cessation (COMMIT) evaluation (6). This report examines the findings of these surveys on the cigarette brand preferences of adult and teenaged smokers.

Aspects of statistical design for the community intervention trial for smoking cessation (COMMIT)

We present statistical considerations for the design of the Community Intervention Trial for Smoking Cessation (COMMIT). One outcome measurement, the quit rate in randomly selected cohorts of smokers, is compared with another outcome measurement, the decrease in smoking prevalence, in terms of statistical efficiency and interpretability. The COMMIT study uses both types of outcome measurements. The merits of pair-matching the communities are considered, and sample size calculations take into account heterogeneity among pair-matched communities. In addition to significance tests based on the permutational (randomization) distribution, we also describe approaches for covariate adjustment. The COMMIT design includes 11 pair-matched communities, which should provide good power to detect a 10% or greater difference in quit rates between the intervention and control communities in cohorts of heavy smokers and in cohorts of light or moderate smokers. The power is only moderate to detect intervention effects on the decreases in overall smoking prevalence or in the prevalence of heavy smoking.

Community Intervention Trial for Smoking Cessation (COMMIT): Summary of Design and Intervention

The Community Intervention Trial for Smoking Cessation (COMMIT) is a multicenter project created to test a comprehensive smoking control intervention. COMMIT was designed to effectively reach cigarette smokers, especially heavy smokers, and to aid them in achieving and maintaining long-term cessation of cigarette smoking. COMMIT was also designed to work through communities, using existing media channels, major organizations, and social institutions capable of influencing smoking behavior in large groups of people. This ongoing trial was begun in 1989 in 11 matched pairs of communities. Each pair consists of one community randomized to intervention conditions and one community randomized to comparison conditions. A comprehensive set of mandated activities is organized around four task forces encompassing health care providers, work sites and organizations, cessation resources and services, and public education. Intervention activities are adapted and implemented in each community through a local community board that provides oversight and management of COMMIT activities. Cessation rates will be assessed in randomly selected cohorts of heavy cigarette smokers, identified at the baseline survey and tracked for 5 years, as estimators of the overall quit rates in both intervention and comparison communities. Various data collection methods will be used to provide intermediate outcome measurement and to evaluate implementation. These methods include cross-sectional community surveys and surveys of health providers, work sites, religious organizations, cessation resource providers, and other systems used to track smoking control activities. The trial will have an impact on more than 200 000 adult smokers.

Community Intervention Trial for Smoking Cessation (COMMIT): Opportunities for community psychologists in chronic disease prevention

Opportunities for participation in chronic disease prevention programs are discussed in the context of a description and analysis of the National Cancer Institute's Community Intervention Trial for Smoking Cessation (COMMIT). COMMIT involves 11 matched pairs of communities with random assignment to the intervention condition within each pair. The 4-year intervention is guided by a partly standardized protocol and embodies a number of community psychology principles. The relative congruence of COMMIT with community psychology principles and methods is discussed with particular emphasis on Kelly's (1988) model of community research. Community psychology's participation in chronic disease prevention trials requires understanding of the programmatic framework of National Institutes of Health prevention research and recognition of the constraints imposed by the framework on community psychology practices.

Introduction to the Community Intervention Trial for Smoking Cessation (COMMIT)

The Community Intervention Trial for smoking cessation (COMMIT) is sponsored by the National Cancer Institute and involves eleven pairs of communities in North America. COMMIT emphasizes a partnership between the eleven research institutions and their respective intervention communities in developing the structures needed to implement the intervention protocol. We summarize the epidemiological data and describe the prior community interventions that set the stage for COMMIT, and discuss how COMMIT may inform state-wide tobacco reduction demonstration programs. An overview of the articles that describe the COMMIT intervention and evaluation plan is presented.

Evaluation Plan for the Community Intervention Trial for Smoking Cessation (COMMIT)

The National Cancer Institute is sponsoring the Community Intervention Trial for Smoking Cessation (COMMIT), a multi-center research project designed to test the value of a community-based effort to promote smoking cessation. The trial involves eleven matched pairs of communities with random assignment of one community per pair to the intervention or to the comparison condition. This article reviews the rationale and methodology of the COMMIT evaluation plan which is organized into four components: 1) outcome assessment, monitoring changes in community smoking patterns; 2) impact assessment, measuring the effect of the COMMIT intervention on mediating factors thought to be important in facilitating changes in community smoking behavior (e.g., social norms supporting nonsmoking); 3) process assessment, monitoring the quality and timeliness of intervention delivery; and 4) economic assessment, estimating the cost effectiveness of the intervention.

Promoting Smoking Control through Worksites in the Community Intervention Trial for Smoking Cessation (COMMIT)

This article describes the worksite intervention and assessment aspects of the COMMIT project. Following a brief review of the rationale for worksite smoking control efforts and how planning for such activities can be conducted as part of community-based interventions, we describe the COMMIT worksite protocol. All intervention communities conduct specified activities in the areas of smoking policy, motivational and incentive procedures to encourage smoking cessation, and provision of self-help materials and cessation services for employees. Assessment procedures include a computerized process objectives system, surveys of worksites in each of the 22 COMMIT communities, and work related questions on surveys of community residents. Baseline data that have informed the process objectives for the worksite channel are presented, as are examples of how intervention activities have been tailored to different communities.

Principles of Community Organization and Partnership for Smoking Cessation in the Community Intervention Trial for Smoking Cessation (COMMIT)

The Community Intervention Trial for Smoking Cessation (COMMIT) has adopted a community approach to smoking cessation. State-of-the-art interventions that have proven efficacious for smoking cessation are delivered to smokers through community-based organizations. An innovative adaptation of community organization methods accommodated the need for a standardized protocol with the flexibility required for diverse and unique communities. The unique characteristics of the eleven intervention communities are examined with a focus on differences in size, location, availability and importance of the intervention channels, and other factors that were important for community mobilization. Initial results of the mobilization process are summarized. Although there were some differences in the structures formed and the time required to complete the initial project activities, all eleven intervention sites were mobilized around the COMMIT goals and activities.

Health Care Providers as Key Change Agents in the Community Intervention Trial for Smoking Cessation (COMMIT)

The Community Intervention Trial for Smoking Cessation (COMMIT) is a multi-center collaborative trial sponsored by the National Cancer Institute. COMMIT utilizes multiple, community-based channels to facilitate quit attempts among heavy cigarette smokers. The "health care provider channel" is important, in that physicians, dentists, and other health care providers can effect changes in smoking behavior at both the individual and community level. There are over 1,600 primary care physicians and general practice dentists in the COMMIT intervention communities. This article describes the conceptual basis for the health care provider activities; results of a survey of community attitudes and behaviors regarding smoking and health care; specific training and intervention activities; and the role of health care providers as community change agents in the smoking cessation arena.

Process Evaluation in the Community Intervention Trial for Smoking Cessation (COMMIT)

The reach and complexity of the multi-site Community Intervention Trial for Smoking Cessation (COMMIT) project call for an extensive, comprehensive evaluation plan. This article reports on the objectives, methods, and data sets of the part of the plan designed for process evaluation. We describe the systems developed for: monitoring progress in the sites, the quality of local intervention activities and data collection, and compliance with the trial-wide protocol; disseminating information for formative purposes; and generating and using process data for outcome evaluation. The process evaluation approach includes both quantitative and qualitative methods. We provide examples from community mobilization and intervention in different communities.

Assessing the gain in efficiency due to matching in a community intervention study

COMMIT (Community Intervention Trial for Smoking Cessation) is a randomized study employing a matched pairs design. Pairs of communities were selected on the basis of their geographical proximity and were chosen to be matched on variables strongly expected to relate to the outcome variable, the smoking quit rate. However, quantitative information was not available to evaluate the efficiency gain from matching. We have used baseline smoking quit rates in the communities as a surrogate for the outcome measure to evaluate the gain in efficiency from the matching. Our method takes account of the possible imperfection of the surrogate as a representative of the true outcome. The method estimates an efficiency gain of at least 50 per cent using the matched design. We also evaluate the further gains in efficiency which would be made by using the baseline quit rate to balance the randomization.