|
Important gains have been made in reducing tobacco use prevalence in California and the U.S. in part by implementing intervention strategies that reflect understanding of tobacco use in diverse at-risk groups. However there remain substantial populations for which, whether because of co-morbidities or other circumstances, progress has yet to occur. Persons with other substance abuse problems are one such group. Smoking rates are high in this population and alcohol and other substance use increases the adverse health effects of tobacco use. Although there is growing interest in including smoking cessation intervention in substance abuse treatment and recovery programming, attempts to use cessation strategies developed for the general population have not met with wide success, and tailored interventions for this population have yet to be developed. The limited research that has been conducted has involved small sample sizes, has resulted in equivocal findings, and has not taken into account subgroup characteristics, gender, race/ethnicity, other socio-cultural factors, that are likely to be relevant to cessation. Addressing the need for tobacco-use cessation among persons with other substance abuse problems remains a significant challenge. To address this unmet need, the goal of our overall program of research is to develop, test, and widely disseminate an effective smoking cessation program for persons in substance abuse treatment and recovery, who comprise an underserved and understudied population. As a first step we propose in this pilot CARA to establish a strong community-academic partnership that will allow us to explore, through collection and analysis of in-depth qualitative data, perceptions of individual, institutional, programmatic barriers and supports to implementing smoking cessation intervention into substance abuse treatment and recovery programming; and how best to tailor, implement, and deliver evidence-based smoking cessation strategies for this population. We focus on African American substance abusers in this initial research because of the heavy burden of tobacco and other substance use in this community; and because we view in-depth consideration of socio-cultural factors in one group to be a valuable starting point, providing an opportunity to gain insight into the types of issues that may well need to be taken into account for other subgroups and substance misusers, overall. Specific Aims of this Pilot CARA are to: (1) Forge a community/academic research partnership between Healthy African American Families (HAAF) and the UCLA Division of Cancer Prevention and Control Research, School of Public Health and Jonsson Comprehensive Cancer Center (UCLA/DCCC/SPH/JCCC). A Community Council will guide the research, utilizing the Community Partnered Participatory Research Model (CPPC) and the Health Behavior Framework. The Community Council will include community members with particular interest, awareness, and understanding of substance abuse problems, and persons who serve this community through substance abuse counseling and treatment programs. (2) Conduct a minimum of 6 working (focus) group sessions among (n= 50) African-American men and women in substance abuse treatment or recovery programs. (3) Complete individual, in-person dialogues (interviews) with at least 8 stakeholders, health care providers and community leaders in the Los Angeles area who provide services to persons in treatment or recovery for substance abuse. (4) Integrate what is learned through the working group sessions and in-person dialogues to draft the content for a tailored theory-driven tobacco use cessation intervention for use by persons in in- and out-patient substance abuse treatment and recovery programs, in preparation for a Full CARA application. Our pilot study will establish the foundation for this later research, through which we will seek to develop, test and disseminate the tailored tobacco cessation program we craft. We will share our findings with the community and with professionals providing services to the community as we shape these next steps in our overall program of research. |
