Assessing the effectiveness of virtual versus in-person peer-motivation smoking cessation interventions for youths and adults

The overarching goal of this study is to apply Community-Based Participatory Research to reduce tobacco use among low-income communities in Baltimore through community-based smoking cessation interventions. Tobacco is a significant public health problem, particularly among residents of low-income communities partly due to the lack of active participation of such communities in research and insufficient use of modern technologies. Group counseling and support in addition to health education and nicotine replacement therapy have been shown effective in significantly increasing the odds of long-term smoking cessation among underserved clients while reducing the cost of providing services in clinical settings. Furthermore, new online and communication technologies have offered novel opportunities for increasing the outreach and effectiveness of smoking cessation programs and reducing the cost. In 2008, Morgan State University formed a Community Based Participatory Research partnership with its neighboring communities, namely CEASE (Communities Engaged and Advocating for Smoke-free Environments). Since then, CEASE has tested four phases of smoking cessation interventions in clinical and community settings using group and individual counseling, nicotine replacement therapy, and contingency management plans. As a result, a promising peer-motivation intervention has been evolved with CEASE branded tools and manuals that can be offered by qualified trained residents in community venues such as churches, schools, public housing, and drug recovery centers. Given the high cellphone ownership rates in the Unites States5, in the next stage, we are planning to build upon the established foundation described above and conduct further research on refinement of the model and incorporation of communication technologies.

To achieve this, we propose the following specific aims:

• Specific Aim 1: Develop and test a culturally appropriate virtual peer-motivation intervention platform designed to support tobacco education and cessation, participants' recruitment, and relapse prevention 
• Specific Aim 2: Compare the effectiveness of the virtual peer-motivation versus a previously tested inperson peer-motivation on short and long-term smoking cessation outcomes
• Specific Aim 3: Explore potential predictors and identify factors associated with better utilization and effectiveness of each intervention

The project will build on a long-term successful community-campus partnership to reduce health disparities caused by tobacco through experimental and mix-methods research designs. The study will be conducted in underserved communities of Baltimore and includes the following components: (1) assessing the community needs and resources regarding tobacco use, access to tobacco products and marketing, and use of technology among the younger and older generations of participating communities of Baltimore; (2) using local data to inform the design and pilot testing of a virtual tobacco education and cessation intervention in collaboration with community partners; (3) comparing the relative advantage of the virtual peer-motivation
intervention with a conventional in-person intervention both adapted to the needs of youth and older adults; (4) assessing the effectiveness of the virtual intervention using qualitative methods to further enhance the quality of the curriculum; and (5) disseminating the findings and generating actions at the local level by facilitating community-engaged tobacco counter-marketing and tobacco use prevention programs.

Specific Aim One will be achieved through: first, restructuring the existing Community-University partnership into a Community Steering Committee based in the community engagement core and new subcommittees; second, conducting a community assessment and asset mapping relevant to the needs of the proposed study; and third, co-developing a virtual peer-motivation version of the CEASE smoking cessation program tailored to the needs of both younger and older participants in collaboration with community partners.

To achieve Specific Aim Two, first the virtual peer-motivation intervention will be pilot tested and revised with input from the community in collaboration with a faculty from Computer Science. Then, participants will be recruited from three types of randomized settings where they receive either the virtual peer-motivation or the conventional in-person intervention, or serve as the control group. The effectiveness of the program will be assessed based on individuals' level of participation and their tobacco use status at a four-month follow-up after the end of the program. The study will be implemented in two adapted versions for 14- to 21-year old youth and those older than 21.

Specific Aim Three will be achieved through qualitative assessment of the participants' experiences and their perception of the program followed by effective dissemination of the findings at the local level.