A government-funded study suggests that physicians who want patients to quit smoking for good might do well to recruit local churches as health-care partners.
In a year-long study among African-Americans, Johns Hopkins researchers found that nearly twice as many smokers who received support from pastors and fellow parishioners made progress toward quitting as compared to those who got only a self-help pamphlet at their churches.
Hopkins preventative health specialists pioneered the concept of church-based health programs nearly 20 years ago. In 1989, Hopkins and East Baltimore black churches formed a partnership, and today 250 churches train pastors and members to promote medical compliance and lifestyle changes needed to treat and prevent heart disease, lung disease and stroke. Fifteen cities nationwide now have similar programs, says Diane M. Becker, Sc.D., senior author of the study, which was funded by the National Institutes of Health and is published in the May/June issue of Preventive Medicine.
"Our findings suggest that the best smoking-cessation program for urban African-Americans is tailored not only to each person's stage but also culturally and spiritually based in churches," says Carolyn C. Voorhees, Ph.D., the study's lead author and an instructor of medicine.
"What's unique about this program is that many of the smokers originally didn't want to quit, but ended up making progress toward quitting just by being in church in a persuasive environment," says Becker. "That finding has incredibly important public health implications."
Ninety-two people received an anti-smoking pamphlet in their churches, while 199 people underwent an intensive program that included pastoral sermons, testimony during church services from people going through the program, counseling by specially trained volunteers, individual and group support, gospel music audiotapes and an anti-smoking booklet based on Biblical passages that emphasize good health. The participants, who represented 21 churches, fell into one of five stages, ranging from not planning to quit to quitting and staying smoke-free.
After one year, researchers found that 20 percent of those in the intensive program quit smoking and 47 percent made progress toward quitting, while in the self-help program the rates were 15 percent and 34 percent, respectively. Also, 25 percent of the self-help group relapsed to earlier stages, compared to 17 percent in the intensive program. In both groups, most people who improved moved up one stage rather than several stages. Overall, progress was highest among Baptists in the spiritually-oriented program, perhaps because they consider smoking to be a "sin," according to the study's authors. Those reporting they had quit were given saliva and breath tests for tobacco residue.
"Our findings confirm that the church's cultural and spiritual norms make it an ideal place for health-promotion and disease-prevention programs," says Voorhees. "The spiritually-oriented program emphasized giving yourself up to a higher power to allow the spirit to guide quitting rather than the usual method of taking control of yourself."
Smoking has declined greatly among white Americans but only slightly among African-Americans in the last several years. Recent studies suggest that smokers go through several stages before quitting for good.
Other investigators were Frances A. Stillman, Ed.D., Robert T. Swank, M.A., Patrick Heagerty, Ph.D. and David M. Levine, M.D., Sc.D.