DESCRIPTION (provided by applicant): The 37 million Americans who live in poverty smoke at twice the rate of other Americans. As a result, those living in poverty bear a disproportionate burden from tobacco-related diseases, including lung cancer, other lung diseases, and heart disease. A number of beliefs serve as barriers to their use of evidence-based treatment for tobacco dependence. These beliefs include: 1) smoking is both normative and acceptable under some conditions; 2) willpower is sufficient for quitting rendering outside help unnecessary and irrelevant; 3) evidenced-based treatments are not more effective than other methods; 4) quitting medicines are ineffective, dangerous, addicting, and/or too expensive; and 5) treatments for quitting are not available, hard to access, and/or too expensive. Also, while the poor have as much desire to quit as others, their motivation to make a quit attempt in the near term is less than that of other smokers. New ways are needed to bring evidence-based treatment to this hard to reach population. Providing a brief tobacco dependence intervention to the poor seeking services from community agencies is one such way. Specifically, this study will examine the effectiveness of a brief cognitive-motivational intervention designed to challenge these beliefs and motivate a quit attempt by smokers not otherwise motivated to quit who are presenting for services at the Salvation Army (N=140) relative to an attention control group (N=140), a no-treatment control group (N=140), and smokers who are motivated to quit (N=100). The primary outcome is acceptance of a brief treatment intervention. Other outcomes are subsequent quit attempts and abstinence through three months of follow up. In addition, community agency staff who administer the interventions will complete a survey to assess its feasibility in the community agency setting. Data will be analyzed to evaluate study aims: 1) Did the brief cognitive-motivational intervention result in greater acceptance of treatment, quit attempts using evidenced-based methods, and abstinence than the control groups? 2) Did the intervention boost treatment acceptance and quit attempts above the rate by smokers already motivated to quit? 3) Is the intervention feasible for use in community agencies and acceptable to its cliental? If these aims are achieved, a brief, practical, and effective intervention can be available from community agencies that motivates smokers living in poverty to make quit attempts using evidenced-based methods. Wide distribution of this tailored intervention will help decrease the health disparity experienced by smokers living in poverty.
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