UW-CTRI has received an NIH grant to train staff at four Salvation Army centers to provide a brief intervention with clients who smoke. UW-CTRI researcher Bruce Christiansen will lead the project.

“Social service agencies have access to the poor,” Christiansen said, “so we’re going to train them to provide a 15-minute intervention to those who aren’t ready to quit.” While 70 percent of smokers say they would like to quit, few are ready to quit—or even set a quit date—when asked. Christiansen hopes that a brief intervention by Salvation Army staff can turn that around.

He knows it won’t be easy. Research shows many people who are homeless or very poor have either mental-health or substance-abuse issues. Both of these groups tend to smoke at high rates and struggle more than most to quit. So the grant offers modest financial incentives to the smokers and also removes barriers to quitting. For example, while the intervention is just one short session for practical reasons, the Salvation Army has agreed to make telephones available for smokers to call the Wisconsin Tobacco Quit Line.

Christiansen plans to recruit 140 smokers total who aren’t ready to quit from Salvation Army locations in Green Bay, Appleton, La Crosse and Wausau. There’s a follow-up phone call after three months, also with a modest incentive to those who participate.

More than 37 million Americans live in poverty, and they smoke at twice the rate of other Americans. As a result, they bear a disproportionate burden from tobacco-related diseases. A number of beliefs particularly prominent among those living in poverty create barriers to their use of evidence-based treatment. These beliefs include:

1) Smoking is both normal and acceptable.
2) Willpower is sufficient to quit, rendering outside help unnecessary and irrelevant.
3) Evidenced-based treatments are not more effective than other methods.
4) Stop-smoking medicines are ineffective, dangerous, addictive and/or too expensive.
5) Help in quitting is not available, hard to access and/or too expensive.

The goal of the intervention is to correct these misconceptions so they’ll consider quitting smoking. As a control, another 140 clients will be randomized into a 15-minute intervention with a Salvation Army counselor reading through a booklet on smoking and health, but without any behavioral or motivational interviewing. Another control group, consisting of 140 clients, will be given a booklet to peruse by themselves. The two-year grant goes until September 2013 and is for $332,000.