Experiences of a community-academic partnership in developing and implementing a lay health advisor perinatal tobacco cessation program

Pregnancy provides a brief yet robust window of opportunity for positive health behavior change, including tobacco cessation. Although there has been a steady reduction in perinatal tobacco use over the past several decades, women of lower socioeconomic status and certain minority groups have experienced slower rates of decline and there is evidence of a worsening disparity in perinatal tobacco use by social class. This presentation examines the experiences of a community-academic partnership in developing and implementing an evidence-based, lay health advisor-driven perinatal tobacco cessation program for low income, predominately African American and Hispanic women. This work highlights one of the first applications of the 5A's tobacco cessation model – a brief yet highly effective counseling approach – administered by lay health advisors within a community-based setting. A multi-method process evaluation, including client chart reviews, pre-post tests of lay health advisor training and qualitative key informant interviews was conducted to analyze three domains of program implementation: fit within the community context, fidelity to intervention protocols, and feasibility of implementation. Findings indicate that project partners succeeded in bringing state-of-the-art tobacco cessation programming to an underserved population. Success was largely attributable to two predominant factors: 1) the utilization of a scientifically-validated intervention model; and 2) the emphasis on continuous lay health advisor capacity development. The experiences of our program can provide useful lessons for similar efforts among lay health advisor programs and community-based organizations and help to expand the availability of evidence-based tobacco control resources for perinatal women in low income and minority communities.