Department of Oncology - Smoking Cessation Program - Montefiore Einstein Center for Cancer Care - New York City
We understand that quitting smoking is essential to good health, crucial to cancer prevention — and extremely difficult. To help provide the guidance and support most people need, Montefiore has developed a six-session Smoking Cessation Program, open to the community and offered in both English and Spanish.
A six-week smoking cessation program was designed to address the cognitive, behavioral, and physiological aspects of smoking cessation in an urban population. Fourteen of 15 (93%) smokers who completed the program assessed the helpfulness of individual components of the intervention. The participants' mean age was 57 years (aged 19-77) 71% were female, and 71% were high school graduates. Participants attended a mean of five sessions, with 57% attending all six. At the final session of the intervention, the following components were rated as very-to-extremely helpful: sharing with and hearing from other group members (93%), learning about substitute behaviors, including distraction and delay techniques (78%), the use of a smoking behavior log (72%), self-talk (71%), information provided by a M.D. concerning nicotine replacement (71%), using positive affirmations (65%), self-hypnosis (65%), hearing from a cancer survivor (64%), and weekly homework assignments which addressed topics covered in each session (58%).
Overall, the smoking cessation program was rated as very-to-extremely informative and helpful. This intervention was successful in 20% of participants, a large proportion when compared to other programs. Among patients who continue to smoke, there was a reduction in the average number of cigarettes smoked per day (mean = 24 before versus 11 after), and mean increase in motivation (6 versus 8) and confidence to quit (4 versus 8) on scales from 1 to 10. This program evaluation illuminates intervention components that may motivate quitting for use in the development/refinement of other smoking cessation programs.
A health psychologist developed the Quit Smoking Group of the Community Outreach Program of the Albert Einstein Cancer Center in March 2001 to assist motivated residents in quitting smoking. This program is a six-week educational group series consisting of cognitive restructuring, behavioral tools, relaxation, psycho-education, and self-hypnosis, augmented by guest speakers, readings, homework assignments, and an attendance-based financial incentive. The program is lead by trained volunteers consisting of health psychology graduate students, medical students, physicians and college graduates. Sessions are 1.5 hours each, and have taken place at the Jack D. Weiler Hospital in either a conference room or auditorium. In an effort to reach more people, groups will also be offered at the Albert Einstein Cancer Center Outpatient Clinic at Montefiore Medical Park and at Montefiore Medical Center.
The educational content of each session is cumulative with the primary goal to provide group members with the cognitive, behavioral and motivational tools to take action in quitting smoking. The volunteer guest speakers featured each week include: a physician who discusses nicotine replacement options, a licensed health psychologist who elaborates on cognitive-behavioral strategies, a survivor of a smoking-related cancer, and a former smoker who has successfully quit.
As an added incentive for smokers to attend all sessions, a nominal fee is charged ($50) for which $5 is refunded for each session attended, resulting in a maximum cost of $20 for those who attend the program in full. All funding goes towards the cost of running the program including the educational materials, motivational tools (e.g., "ciggy bank"), certificates of completion and a celebratory "graduation" at the final session.
Eligible participants are English or Spanish-speaking smokers who are willing to provide a "quit date" at the start of the group. Recruitment is done via advertising in flyers at Einstein/Montefiore/Weiler, local newspapers, local fitness centers and church/synagogue bulletins.
Anonymous self-report evaluations (coded by last four digits of SS#) will be administered at two points in time: T1- at the first session and T2- at the final session. These 10-minute surveys will query participants on tobacco use history, sociodemographic and health background, past quitting history, nicotine dependence (Heatherton, 1991), nicotine withdrawal symptoms (Hughes et al, 1991), confidence and motivation to quit, and locus of control for smoking (adapted from Hartmann, 1999). The T2 survey will additionally assess participants' feedback about the helpfulness of the teaching methods and tools provided in the group, barriers to quitting, use of pharmocotherapy, and reasons for non-attendance. In addition, participants will be queried about their smoking status via anonymous post-card at 3 months and 1 year following intervention.
Research Questions and Data Analysis
This program evaluation study will be used to improve the smoking cessation services offered by the Montefiore-Einstein Center for Cancer Care.
What are the short-term and long-term smoking cessation rates among those who participate in the Community Outreach Program Quit Smoking Program?
Descriptive statistics will be used to describe the percentage of abstainers, relapsers, continuous smokers, and late quitters based on session six, three-months, and one-year smoking status data.
What are the predictors of long-term smoking cessation among Program participants?
Multivariate data analysis (regression analysis) will be used to determine predictors of smoking cessation at one year. These predictors will include (T1) sociodemographics, motivation to quit, confidence in the ability to quit, smoking history (including past attempts and methods by which to quit), nicotine dependence and withdrawal, and locus of control, as well as (T2) group satisfaction, attendance and homework compliance.
What intervention components are perceived as beneficial to participants of the Program?
Process evaluation analysis will use descriptive statistics (e.g., frequencies) to examine perceived helpfulness of the teaching methods and quitting tools (e.g., role playing, self-talk, hypnosis and guest speakers) provided in the group.
Hartmann, DJ. Replication and extension analyzing the factor structure of locus of control scales for substance-abusing behaviors. Psychological Reports, 1999, 84, 277-287.
Heatherton TF, Kozlowski L, Frecker RC, Fagerstrom KO. The Fagerstrom Test for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire. Br J Addict 1991 Sep;86(9):1119-27.
Hughes JR, Gust SW, Skoog K, Keenan RM, Fenwick JW. Symptoms of Tobacco Withdrawal. Arch Gen Psychiatry. 1991, 48:52-59.
Principal Investigator: Alyson Moadel, Ph.D.
Co-Investigator: Petra Lukoschek, M.D., MPH