Examining Dropout in a CBPR Approach to Smoking Cessation: Lessons Learned from the CEASE Partnership

CEASE (Communities Engaged and Advocating for Smoke-free Environments) builds on a 13-year partnership between Morgan State University and Southwest Baltimore. Now in its third phase, CEASE has learned from and revised each intervention to increase retention, the single best predictor of success in quitting smoking.

Phase I included weekly interventions over 12 weeks conducted in a Community Health Center by CHC health personnel. Participants were assigned randomly to individual or group counseling. Of the 400 participants, 9.4% quit smoking; among the 13.7% who attended more than six sessions, the cessation rate was 27.3%. Post-intervention research revealed that: participants did not like the health care setting; they wandered in and out of their assigned groups; health providers were not especially effective.

Because the Phase I outcomes were the same for both individual and group counseling, and the group approach was much more cost-efficient, Phase II used only groups who met in community settings. Instead of health personnel, Peer Motivators were recruited from the same neighborhoods they served, and trained to deliver the 12-week intervention. Improving the cultural competence of the group leaders, meeting in familiar places, and closing the group to increase cohesion improved retention. Of the 386 participants who started Phase II, 21.8% quit smoking. Of the 40.9% who attended more than six sessions, 40.5% quit.

Phase III is taking advantage of all lessons learned to continue improving retention and cessation rates. Perhaps the most important lesson is that quitting smoking is more of a social than a clinical event.