Smoking Cessation Tailored to Rural Young Adult African American Men:

Despite smoking fewer cigarettes daily, African American (AA) men suffer higher morbidity and
mortality associated with tobacco-related disorders than whites. Our preliminary data shows
that 39.9% of AA men between 19 and 30 years of age who resided in rural Alabama smoke
cigarettes. Although it has been well established that a combination of pharmacotherapy and
advice-oriented counseling and/or cognitive behavioral interventions are efficacious in
promoting smoking cessation across diverse populations, these evidence-based treatments for
tobacco dependence have not proven to be effective/efficacious (or even accessible) among
some subpopulations suffering disproportionally from tobacco-related morbidity and mortality.
The overall goal of this feasibility study is to make adaptations to these evidence-based
approaches, and develop, implement, and examine the feasibility and scalability of a
theory-based, culturally relevant smoking cessation intervention for young adult AA men in
rural Alabama who smoke cigarettes. Our formative assessments point to a cognitive-behavioral
intervention delivered by a trained Community Health Worker with the support from an "expert"
physician who can deliver the pharmacological component via Skype through an integrated
approach. The proposed study will address the next three steps in this process: development
of the intervention, pretesting, and feasibility. First, we will develop the intervention
with input from a Community Advisory Committee, followed by an iterative process by which the
target audience will be exposed to materials and messages to provide feedback (pretesting).
Once all intervention components are finalized, we will recruit participants, randomly assign
them to intervention/control groups, pilot test, and evaluate the intervention. The
comparison group will be the Alabama Tobacco Quitline with 8 weeks of Nicotine Replacement
Therapy to be consistent with the pharmacological approach proposed for the intervention. The
primary outcome will be 7-day point prevalence abstinence (defined as no cigarettes in the
past 7 days and verified through measurement of exhaled carbon monoxide levels) at 6-month
follow-up. We will also conduct detailed treatment fidelity and scalability assessments
(acceptability, feasibility, potential reach and adoption, alignment with the strategic
context) to inform a full-scale efficacy trial.

Inclusion Criteria:

(a) African American; (b) men; (c) between the ages of 18 and 30; (d) residing in Sumter
and Greene counties; and (e) smoked cigarettes within the past seven days. For the
feasibility testing of the intervention, participants must have a permanent residence in
the county and no intent to move within the next 12 months.

Exclusion Criteria:

- Recent MI and unstable angina.