Community-based programs for smoking cessation.

: Overall, there is a wide range of programs offered at the community level. Most of the group cessation clinics, both nonprofit and commercial, typically offer group support, behavior modification, and stress and weight management, with similar emphases in their companion self-help manuals. It often is difficult to distinguish between the various methods employed by the diverse programs, with those that offer maintenance and relapse prevention components faring the best. In general, the multiple-component programs, whether group or self-help packages, seem to hold the most promise for achieving and maintaining abstinence; however, there is some evidence that overwhelming the smoker with too many new behaviors and skills lowers the effectiveness of otherwise successful components. The challenges for community-based programs will be to modify and adapt their materials and sessions to address the needs uncovered in the recent emphasis on the process of smoking cessation. Specifically, program content must address the issue of recycling and relapse prevention. Smokers who have made unsuccessful quit attempts must be able to reframe those attempts in a positive manner, so that they are motivated to try again. Similarly, recent quitters need the skills and motivation to remain abstinent. Although some cessation programs allow clients to participate in future sessions or meetings for little or no extra cost, few have any strategies for dealing with long-term maintenance. As community-based programs incorporate these elements of cessation, quit rates are likely to increase. An additional challenge is found in the difficulty of reaching the hard-core, heavy smoker. There is little doubt that light-to-moderate smokers find it easier to achieve long-term cessation. Cessation programs that motivate heavy smokers to attempt to quit or that include adjunct therapies to assist the heavy smoker (i.e., nicotine gum) to quit smoking are likely to be positively received. Currently, however, efforts specifically designed to assist heavy smokers are experimental. A final challenge is to adapt materials and sessions to motivate and assist the hard-to-reach smokers. Increasingly, smoking is becoming a habit of individuals in lower socioeconomic groups, including minorities, non-high school graduates, and young women. Avenues that have been used to reach white middle-class Americans are not easily transferred to such groups. Some attention is already being paid to development of more culturally appropriate materials (e.g., the ALA Manual oriented to blue collar workers and the ACS focus on pregnant women); however, it remains a challenge to motivate members of these groups to participate in smoking cessation activities.(ABSTRACT TRUNCATED AT 400 WORDS)