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


CONCLUSIONS
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.
Division of Health Behavior and Health Promotion, College of Public Health, Ohio State University, Columbus, OH.
Mary Ellen
ME
Wewers
Division of Biostatistics, College of Public Health, Ohio State University, Columbus, OH.
Abigail
A
Shoben
Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH.
Sara
S
Conroy
Division of Health Behavior and Health Promotion, College of Public Health, Ohio State University, Columbus, OH.
Elana
E
Curry
Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH.
Amy K
AK
Ferketich
Office of Disease Prevention, National Institutes of Health, Bethesda, MD.
David M
DM
Murray
Division of Health Behavior and Health Promotion, College of Public Health, Ohio State University, Columbus, OH.
Julianna
J
Nemeth
Division of Health Behavior and Health Promotion, College of Public Health, Ohio State University, Columbus, OH.
Amy
A
Wermert
D000293:Adolescent; D000328:Adult; D001061:Appalachian Region / Q000453:epidemiology; D003150:Community Health Workers / Q000523:psychology* / Q000706:statistics & numerical data / Q000639:trends; D003376:Counseling / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D015277:Hotlines / Q000706:statistics & numerical data; D006801:Humans; D057187:Independent Living / Q000523:psychology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D058991:Patient Protection and Affordable Care Act / Q000639:trends; D012017:Referral and Consultation / Q000706:statistics & numerical data / Q000639:trends; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology*; D014029:Tobacco Use Disorder / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
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