Statewide Implementation of the Self-Help Version of the Cooper Clayton Method to Stop Smoking in Kentucky

Jennifer Redmond, MPH • Robin Vanderpool, DrPH, CHES • Richard Clayton, PhD • Thomas Cooper, DDS • RaeAnne Davis, MSPH

BackgroundTobacco use is the leading actual cause of death in the United States causing an estimated 430,000 deaths each year (Mokdad, AH, Actual Causes of Death, 2004).

From 1998-2002, Kentucky had the highest rate of lung cancer mortality among men, 114.0 per 100,000 males compared to 76.3 per 100,000 males in the U.S., and the second highest rate of lung cancer mortality among women, 53.7 per 100,000 females compared to 40.9 per 100,000 females in the U.S. (ACS Facts and Figures, 2006).

Kentucky has the highest rates of adult smoking in the nation (BRFSS, 2006):

Primary ObjectiveTo determine the effectiveness of the self-help method in a larger population that would include Appalachian and non-Appalachian residents.

Methods

Eligibility:Eligible participants were those who:• smoked at least 10 cigarettes a day• were not currently enrolled in a smoking cessation

program or currently using Nicotine Replacement Products

• were ages 18 or older and• were residents of Kentucky.

Enrollment Procedure:An interested participant could talk with a KCP staff member either over the phone or in person to receive the study materials as well as the Self-Help Kit.

Follow-up Procedures:At 12 and 24 weeks the post-tests were mailed to the participants. If the post-tests were not received, the study staff called to conduct the post-test over the telephone.

Conclusions• Participants who completed the 12 and 24 week surveys

reported that nicotine replacement therapy (e.g., patch, gum, lozenge) was the most helpful in their effort to become nonsmokers.

• Over 95% would recommend the Cooper Clayton Self-Help program. • Participants commented that the expense of nicotine

replacement therapy was the greatest barrier to participating in the program.

• Participants indicated that they would like more support, such as telephone counseling, which is now available through the 1-800-QUIT-NOW state quitline.

30.5%

32.6%30.8%

27.5%28.7%

23.2% 23.2%22%

20.9% 20.6%

The Cooper Clayton Method to Stop Smoking program was developed in 1985 by Drs. Thomas Cooper and Richard Clayton from the University of Kentucky.

Cooper Clayton Method:• Nicotine replacement therapy

(initially the nicotine gum, now includes the patch and the lozenge)

• 12 weeks of group support• Behavioral modification and relapse

prevention.

Research on the program reported a one-year success rate of 40-45%, chemically verified.

The Kentucky Cancer Program (KCP) is a statewide community-based organization with 13 regional offices whose mission is to reduce cancer incidence and mortality in Kentucky through education, service and research programs. KCP has been partnering with Drs. Cooper and Clayton to provide infrastructure and build capacity for smoking cessation across the state since 2000.

6%6%Control

24%24%Self-Help

26%32%Group

24 week success rate12 week success rate

An initial pilot study was conducted by the Kentucky Cancer Program (KCP) and Drs. Cooper and Clayton by modifying the Cooper Clayton Method to Stop Smoking to a self-help version that includes all elements of the program except for the group support. 104 participants were recruited from rural Appalachian counties in Kentucky and assigned to the group method (38), the self-help method (34) and a control group (32).

Barriers to participating in group method:• Distance to group sessions, with rural participants

often having greater distances to travel than urban participants

• Insufficient financial resources to pay for travel to group sessions

• Insufficient numbers of smokers (especially in rural areas) to form the critical mass of participants needed for group dynamics

• Difficulty committing to an intensive program that meets weekly for three months because of job, family or other responsibilities, and

• Unwillingness to participate in group therapy-type sessions.

Based on the results from the initial pilot study, a state-wide study has been conducted to determine the effectiveness of the self-help version of the Cooper Clayton Method to Stop Smoking among both rural and urban populations and with additional support options.

This study was approved by the University of Kentucky Institutional Review Board.

Study Design:This was a non-randomized prospective cohort study in which pre-test data were collected before the intervention began and post-test data were collected at 12 and 24 weeks.

Recruitment: Subjects were recruited through local media (newspaper advertisements, radio announcements, etc.), posters and flyers distributed at hospitals, physician offices, health departments and KCP regional offices.

Self-Help Kit contained:• Cooper Clayton Method to Stop Smoking

Participant Book• Cooper Clayton Method to Stop Smoking Video • “I’m better off as a nonsmoker” magnet• Cooper Clayton web site information• Follow-up encouraging post cards• Local and national smoking cessation resources

36%Male

64%Female

44%Appalachia

56%Non-

Appalachia

41%Lived withA smoker59% Lived

With ANon-smoker

Average age = 47

Average years smoked = 25

Average # of cigarettes a day = 24

Average # of quit attempts = 5

Self-Help Participant Characteristics

Self-Help Results at 12 Weeks Follow Up*

Self-Help Results at 24 Weeks Follow Up*

73%

27%

57%

Female

69%

31%

57%

Appalachia

76%73%Not Successful

24%27%Successful

56%55%Response Rate

Non AppalachiaMale

27%

73%

81%

Female

47%

53%

76%

Appalachia

n/a14%Not Successful

100%86%Successful

88%82%Response Rate

Non AppalachiaMale

* 24 week survey was administered to those who were successful nonsmokers at 12 weeks

Results

* At the end of treatment