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Randomized Controlled Trial
. 2017 Nov 7;19(12):1499-1507.
doi: 10.1093/ntr/ntw265.

Effectiveness of Two Community Health Worker Models of Tobacco Dependence Treatment Among Community Residents of Ohio Appalachia

Mary Ellen Wewers  1 , Abigail Shoben  2 , Sara Conroy  3 , Elana Curry  1 , Amy K Ferketich  3 , David M Murray  4 , Julianna Nemeth  1 , Amy Wermert  1
Affiliations
Randomized Controlled Trial

Effectiveness of Two Community Health Worker Models of Tobacco Dependence Treatment Among Community Residents of Ohio Appalachia

Mary Ellen Wewers et al. Nicotine Tob Res. .

Abstract

Introduction: Community health workers (CHW) may be effective in the delivery of tobacco dependence treatment with underserved groups. This study evaluated two evidence-based CHW models of treatment. It was hypothesized that smokers assigned to a CHW face-to-face condition would have higher abstinence at 12-month posttreatment than smokers enrolled in CHW referral to a state-sponsored quitline condition. Intrapersonal and treatment-related factors associated with abstinence at 12 months were determined.

Methods: A group-randomized trial was conducted with residents of 12 Ohio Appalachian counties with counties (n = 6) randomized to either a CHW face-to-face (F2F) or CHW quitline (QL) condition. Both conditions included behavioral counseling and free nicotine replacement therapy for 8 weeks. Follow-up data were collected at 3-, 6-, and 12-month posttreatment. Biochemically validated abstinence at 12 months served as the primary outcome.

Results: Seven hundred and seven participants were enrolled (n = 353 CHWF2F; n = 354 CHWQL). Baseline sample characteristics did not differ by condition. Using an intent-to-treat analysis (85.4% retention at 12 months), 13.3% of CHWF2F participants were abstinent at 12 months, compared to 10.7% of CHWQL members (OR = 1.28; 95% confidence interval [CI] = 0.810, 2.014; p = .292). No differences in abstinence were noted at 3 or 6 months by condition. Age, marital status, and baseline levels of cigarette consumption, depressive symptoms, and self-efficacy for quitting in positive settings were associated with abstinence, as was counseling dose during treatment.

Conclusions: This research adds to the body of science evaluating the effectiveness of CHW models of tobacco dependence treatment. Both approaches may offer promise in low-resource settings and underserved regions.

Implications: This 12-county community-based group-randomized trial in Ohio Appalachia adds to the body of science evaluating the effectiveness of CHW models of tobacco dependence treatment. Both CHW approaches may offer promise in low-resource settings and underserved regions. These findings are useful to national, state, and local tobacco control agencies, as they expand delivery of preventive health care services postadoption of the Affordable Care Act in the United States.

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References

    1. Ferketich AK, Wang L. An examination of substance use among adults in Ohio Ohio Medicaid Assessment Survey; 2013. https://osuwmcdigital.osu.edu/sitetool/sites/omaspublic/documents/Substa.... Accessed July 15, 2014.
    1. Fisher JL, Engelhardt HL, Stephens JA, et al. Cancer-related disparities among residents of Appalachia Ohio. J Health Disparities Res Pract. 2008;2(2):61–74. http://digitalscholarship.unlv.edu/cgi/viewcontent.cgi?article=1093&cont.... Accessed March 13, 2016.
    1. Halverson JA. An analysis of disparities in health status and access to health care in the Appalachian region 2004. http://www.arc.gov/research/researchreportdetails.asp?REPORT_ID=82. Accessed July 15, 2014.
    1. Northridge ME, Vallone D, Xiao H, et al. The importance of location for tobacco cessation: rural-urban disparities in quit success in underserved West Virginia Counties. J Rural Health. 2008;24(2):106–115. doi:10.1111/j.1748-0361.2008.00146.x. - PubMed
    1. Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs – 2014. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014. http://www.cdc.gov/tobacco/stateandcommunity/best_practices/pdfs/2014/co.... Accessed March 14, 2016.

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