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Study: Peer Program Helps Childhood Cancer Survivors to Quit Smoking
The Study
The Partnership for Health (PFH) smoking cessation clinical trial is an outgrowth of the Childhood Cancer Survivors Study (CCSS), in which more than 14,000 childhood cancer survivors agreed to be followed over time so that researchers can learn how cancer may affect their lives in the long term.
CCSS participants were eligible to join the PFH trial if they were over the age of 18, were not being treated for cancer, and were active smokers. Researchers enrolled 796 participants from 22 different sites who met these conditions, and randomly assigned them to either a self-help group or a peer-counseling program.
Those in the self-help group received a letter from the trial's doctors explaining that if they quit smoking, they'd lower their chances of getting a secondary cancer. Smokers in this group also received a manual with more tips and information about quitting, including discussion about the benefits of over-the-counter nicotine replacement therapies. Participants were allowed to purchase and use such therapies if they wished, but they had to obtain them on their own.
Those in the other group were assigned a peer counselor, someone who was also a childhood cancer survivor and who had been trained in “motivational interviewing” – an approach that emphasizes the smoker's choice, personal responsibility for change, and self-confidence. The counselors called their assignees up to six times within a seven-month period. Prior to the first call, participants received a written report with “how to quit” information tailored to their personal interests and cancer histories, as captured in the questionnaire they'd originally filled out to join the larger CCSS study.
During the telephone calls, counselors adjusted their comments to meet each participant's particular level of readiness to quit and their interest in other health topics and goals. Extra materials might also be sent, again targeted to the individual. If participants indicated a willingness to try a nicotine replacement therapy, such therapies were provided at no cost. Overall, the peer-counseling program was based on principles from a number of theories about behavior change, with an emphasis on the role of strong social support.
Participants in both groups filled out surveys at eight months and again at 12 months after their interventions began. To increase the likelihood that participants would report the truth about their smoking behavior, researchers told them their saliva would be collected and tested, though this was not done (a technique called the bogus pipeline procedure).
The trial team was led by Karen M. Emmons, Ph.D., of the Harvard School of Public Health and the Dana-Farber Cancer Institute in Boston, Mass.
