Clear Horizons

Cigarette smoking is the leading cause of premature mortality in older adults and has been implicated in 6 of the top 14 causes of death for people age 65 years and older. Cigarette smoking also complicates illnesses and conditions that are more prevalent in older people. Older adults are especially at risk for continued smoking because they 1) have smoked longer, 2) have been and continue to be heavier smokers, and 3) are more likely to have chronic diseases that may be worsened by smoking. Despite these discouraging factors, evidence suggests that cessation of smoking, even at older ages, exerts a protective action that increases with the number of years of life after quitting.

The program, Clear Horizons, is a 48-page self-help guide and telephone counseling protocol specifically tailored for the smoking habits, quitting needs and lifestyles of older smokers. Developed following the principles of adult learning, Clear Horizons follows a magazine style format based on the AARP magazine Modern Maturity. Photos and photo vignettes feature multi-racial smokers in their 50's, 60's, and 70's to provide inspiration and information about quitting that appeal to a broad spectrum of older smokers. Clear Horizons contains information on the health benefits of quitting smoking for older smokers and advice regarding getting ready to quit, quitting, and staying off cigarettes. Clear Horizons also contains advice about nicotine chewing gum, habit breaking and nicotine fading.

For the intervention program, telephone counseling was added as another component to the receipt of Clear Horizons.

Because the intervention is self-administered, between 4 and 52 weeks are needed for implementation, depending on how long people continue to make use of the materials. Self-help aids can be used repeatedly over the first year (or longer) after quitting. The telephone counseling calls average 10 - 15 minutes.

Participants were smokers aged 50 to 74 years from across the United States. Most participants were under 65, overweight, and highly addicted to smoking (90% reported smoking within 30 minutes of rising and 53% smoked 25 cigarettes or more per day.) Women comprised 63% of the sample. The sample was relatively well educated (56% - 62% with more than a high school education).

This intervention is suitable for implementation in the home.

Required resources include the 48-page Clear Horizons self-help guide book. Two counseling calls by BA or MA level health educators with experience in smoking cessation counseling are required to replicate the program as intended.

Smokers aged 50 to 74 years were recruited from across the country through an advertisement in Modern Maturity. Respondents were randomly assigned to one of three conditions: Clearing the Air, an NCI booklet, Clear Horizons alone, or Clear Horizons plus two telephone calls from a smoking cessation counselor. The Clear Horizons guide and the telephone counseling calls were based on the Trans-theoretical Stages of Change model. Telephone calls were made at 4 - 8 weeks and again at 16 - 20 weeks. Protocols were adopted from those found effective in boosting quit rates in previous work. Data were obtained from participants at baseline and 3, 6, 12, and 24 months after intervention delivery.

Results indicated:

• At 3-month follow up, a progressive increase in the self-reported quit rate was from the control, to Clear Horizons alone, to Clear Horizons plus Telephone, 7%, 9%, to 12% respectively.
  
• At 3-month follow-up, participants in the Clear Horizons plus Telephone group were 1.5 times as likely to quit as Clear horizons Guide only subjects and 1.7 times as likely to quit as Clearing the Air subjects.
• Compared with the control group, at 3-month follow-up, higher proportions of participants in Clear Horizons' groups used quitting strategies linked to success in quitting. They were more likely to set a quit date, use nicotine fading, and employ habit breaking techniques.
• At 1-year follow-up, the data suggest treatment effects for both Clear Horizon groups, compared to Clearing the Air group.