title: Community-based navigators for tobacco cessation treatment: a proof-of-concept pilot study among low-income smokers.
abstract: BACKGROUND
  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. 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).
  
  
  METHODS
  The 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.
  
  
  RESULTS
  Eighty-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).
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Department of Community & Behavioral Health, Colorado School of Public Health, Aurora, CO, USA. Arnold.Levinson@ucdenver.edu.|University of Colorado Cancer Center, Mail Stop F542, 13001 East 17th Place, 80045, Aurora, CO, USA. Arnold.Levinson@ucdenver.edu.
authors.forename: Arnold H
authors.initials: AH
authors.lastname: Levinson
authors.affiliation: Department of Community & Behavioral Health, Colorado School of Public Health, Aurora, CO, USA. Patricia.Valverde@ucdenver.edu.
authors.forename: Patricia
authors.initials: P
authors.lastname: Valverde
authors.affiliation: Department of Community & Behavioral Health, Colorado School of Public Health, Aurora, CO, USA. Kathleen.Garrett@ucdenver.edu.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Garrett
authors.affiliation: University of Colorado Cancer Center, Mail Stop F542, 13001 East 17th Place, 80045, Aurora, CO, USA. Michele.Kimminau@ucdenver.edu.
authors.forename: Michele
authors.initials: M
authors.lastname: Kimminau
authors.affiliation: Mercy Family Medicine, Mercy Regional Medical Center, Centura Health, Durango, CO, USA. emilyburns@centura.org.
authors.forename: Emily K
authors.initials: EK
authors.lastname: Burns
authors.affiliation: Department of Community & Behavioral Health, Colorado School of Public Health, Aurora, CO, USA. Karen.Albright@ucdenver.edu.
authors.forename: Karen
authors.initials: K
authors.lastname: Albright
authors.affiliation: Head Start, City of Oakland, CA, USA. dflynn@oaklandnet.com.
authors.forename: Debra
authors.initials: D
authors.lastname: Flynn
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D062405:Motivational Interviewing / Q000379:methods*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011203:Poverty / Q000706:statistics & numerical data*; D020340:Tobacco Use Cessation / Q000379:methods*; D014029:Tobacco Use Disorder / Q000628:therapy*; D014481:United States; D014026:Nicotiana