HEART, BODY, AND SOUL - IMPACT OF CHURCH-BASED SMOKING CESSATION INTERVENTIONS ON READINESS TO QUIT

Background. Given the relatively low spontaneous quit rates and poor t reatment outcomes among African American smokers, this study was desig ned to evaluate the effects of a multimodal culturally relevant interv ention for smoking behavior change compared with a self-help strategy among urban African Americans in Baltimore churches. Method. This rand omized controlled trial in urban African American churches used the st ages of change model to compare the effectiveness of two interventions in moving smokers along a continuum toward smoking cessation. Twenty- two churches were randomly assigned to either an intensive culturally specific intervention or a minimal self-help intervention. Smokers wer e interviewed at baseline church health fairs and at a 1-year follow-u p. Self-reported quitters at follow-up were evaluated using saliva cot inine and exhaled carbon monoxide levels (GO). Stages of change were m easured by applying a standardized stages of change instrument to indi vidual interview response sequences. Analysis compared the two interve ntion groups at 1-year follow-up with baseline stages. Outcomes includ ed quit rates and positive progress along the stages of change. Result s. Multiple logistic regression results, controlling for intrachurch c orrelation and demographic and baseline smoking characteristics, showe d that the multimodal cultural intervention group was more likely to m ake positive progress along the stages of change continuum, compared w ith the self-help intervention group (OR = 1.68; P = 0.04). Church den omination and intervention status interacted in the multi-variate mode l; Baptists in the intensive intervention were three times (OR = 3.23; P = 0.010) more likely to make progress than all the other denominati on groups. Conclusion. The multimodal culturally relevant intervention was more likely than a self-help intervention to positively influence smoking behavior. This is the first community-based intervention stud y to report progress along the stages of change as a process-oriented measure of success. It is notable that a spiritually based model focus ing on environmental sanctions was more likely than a standard church disseminated self-help intervention to positively influence smoking be havior in an urban African American population. (C) 1996 Academic Pres s, Inc.