Smoking Cessation Program Targets Baltimore Residents

Brendell Freeman was a longtime smoker. The 63-year-old estimates she picked up the habit when she was just 13 years old. Over the years, she tried to quit several times but was unsuccessful. A flyer that came to her house at Latrobe Homes, the public housing development near The Johns Hopkins Hospital where she lives, inspired her to try again and led her to finally quit for good.

The flyer provided information about an innovative research study offered by the Johns Hopkins Center to Reduce Cancer Disparities (JHCRCD) and funded by the Maryland Cigarette Restitution Fund. The seed for the program was sown in the late 1980s, when Johns Hopkins staff members started analyzing the health disparities of Baltimore residents based on ZIP codes. “Where people are born and raised is a pretty good indicator of how long they will live,” said Dr. James Zabora, director of education and outreach for JHCRCD. He points out that the life expectancy for a resident of low-income neighborhoods along Madison/East End is 64, compared to 84 for residents of the higher-income neighborhood of Roland Park—even though the communities are only 5 miles apart.

In response to these striking differences, the hospital staff began offering free cancer screenings to low-income community residents. In 2010, the Kimmel Cancer Center formally established JHCRCD with the goal of providing all Maryland communities equal access to cancer prevention and treatment services. The Baltimore City Household Smoking Cessation Project, from which Freeman and other Baltimore residents have benefited, is an example of the center’s work.

The smoking cessation project used a multipronged approach to help residents from communities across Baltimore to quit smoking. It consisted of three group education sessions, nicotine replacement therapy (lozenges, gum and tablets that provide low levels of nicotine while reducing the urge to smoke) and a four-week follow-up period of individualized phone counseling. Latrobe Homes, senior centers and other places provided space for the educational sessions to make participation convenient for residents. Those who successfully completed the program received a $50 Target gift card.

Recruiting by Building Trust

To create an effective smoking cessation effort, Zabora and team knew they would need to gain the trust of prospective participants, many of whom, he notes, “live in the shadows” of Johns Hopkins and may be uncomfortable with health care systems in general. Theron Scott, senior research coordinator for the center, led the recruitment efforts and took a practical, nonthreatening approach to the job. “I try to win the trust of the people. I let them know I’m part of the community,” says Scott, an African-American and former two-packs-a-day smoker. More than 70 residents from Baltimore signed up, and 50 successfully completed the smoking cessation program (47 black, three white).

The timing couldn’t have been better for Freeman and other participants from Latrobe Homes. In July, the housing development instituted a no-smoking policy, and residents will no longer be permitted to smoke in their apartments. Funmi Adekunle, service coordinator for Latrobe Homes Office of Resident Services, says it made sense to work with Johns Hopkins on the study given the new no-smoking policy. It offered a way to support residents interested in quitting smoking, he says. “It’s a wonderful, collaborative relationship,” says Adekunle.

Zabora and Scott originally planned to work only with East Baltimore residents but later made the smoking cessation program available to all low-income neighborhoods of Baltimore City. The program is designed to help all members of the household quit smoking, but Zabora said most participants so far have been single mothers with children or, like Freeman, older adults living alone.

The Education Piece

When Freeman entered the program, she was struggling with several health conditions, including chronic obstructive pulmonary disease (COPD), diabetes and poor circulation. She wasn’t aware of the connection between smoking and poor health. “When I learned how it damaged the body, that helped me a lot,” Freeman says.

Understanding things that may trigger an urge to smoke, and how to manage them, was also very helpful to Freeman. Scott, one of two American Lung Association-certified smoking cessation facilitators who taught the classes, suggested finding a tangible replacement for triggers, such as stress, boredom, part of a routine or ritual, etc. “I tell them they have to find a new way,” Scott says.

Freeman took the lesson to heart. “I would be all right until something upset me,” she says. Now, she reaches for something other than a cigarette or simply waits 10 to 15 minutes until the urge to smoke passes.

Freeman has been cigarette-free for six months, and her health has already improved. She no longer needs an inhaler to help her breathe. When she takes walks, she doesn’t have to stop every few blocks to catch her breath. “I don’t feel like I’m 16, but close to it,” she says with a chuckle.