The Impact of Exhaled Carbon Monoxide Testing and Counseling and Adult Smokers’ Improved Motivation to Enroll in Tobacco Cessation Interventions
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Date
2019-10-22
Type of Work
Department
Public Health and Policy
Program
Doctor of Public Health
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Abstract
While the overall rate of smoking has declined in the general U.S. adult population since the first U.S. Surgeon General’s report on the dangers of smoking, current adult smoking rates vary greatly by socioeconomic status. Smokers in the most underserved communities are often the hardest to recruit into smoking cessation programs and face barriers to enrollment, including low motivation to quit. This investigation, which included 630 adult smokers in Baltimore City, had three aims: to examine whether or not enhancing a recruitment process with exhaled carbon monoxide (eCO) testing and education would, on average, increase the odds of enrollment in peer-led quit smoking classes; to explore, using a sub-sample of 279 smokers, whether or not there were differences in baseline characteristics between enrolled and non-enrolled smokers; and to determine whether the eCO intervention was moderated by motivation change ruler measures of importance, readiness, and confidence (IRC). Study data was collected between May 2015 and March 2016 through the larger Phase IV investigation of the community based participatory research partnership, Communities Engaged and Advocating for a Smoke-free Environment (CEASE). The CEASE initiative trains former smokers to lead quit smoking classes and provides free nicotine replacement therapy to program enrollees in Southwest Baltimore and in neighborhoods within Morgan State University’s Morgan Community Mile. Recruitment activities for the sample occurred through 72 community-based recruitment events in a variety of settings. Population-averaged generalized estimating equations, adjusted chi-squared and adjusted t-tests were used in the analysis to account for the clustered nature of data collection. On average, smokers that received the eCO intervention were 1.8 times more likely to enroll in CEASE programs than the average non-eCO participant (OR: 1.04-3.25). The intervention was more successful in institutional settings than public settings (OR, CI: 2.45, 1.21-4.93). The IRC measures did not moderate the eCO intervention, though there were significant baseline differences in enrollment groups for importance and readiness to change tobacco habits. There were also significant differences between enrollment groups for wanting any support in quitting, being comfortable with the use of nicotine replacement therapy, and Fagerstrom Test of Nicotine Dependence scores. There may be future implications for the incorporation of biomedical risk approaches in community-based smoking cessation program recruitment for low SES populations. Future studies exploring the role of risk perception and the specific roles that importance and readiness play in recruitment processes may also be warranted.