Compared with other preventive interventions, smoking cessation is extremely cost effective (Coffield et al., 2001; Warner, 1997; Cromwell et al., 1997; Croghan et al., 1997; Elixhauser, 1990). According to a recent systematic assessment of the value of clinical preventive services, providing tobacco cessation counseling to adults should be a highly prioritized service because it is both cost-effective and likely to reduce disease burden (Coffield et al., 2001). Implementation of the 1996 Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality) smoking cessation guideline was estimated to gain 1.7 million new quitters in the first year at an average cost of $3,779 per quitter, or $2,587 per life-year saved (Cromwell et al., 1997).
As noted above, the more varied the means of encouragement of nonsmoking are, the greater the rates of abstinence that are achieved. This fact and the desirability of reaching large numbers of smokers have fueled efforts to promote nonsmoking across entire communities.
Among community-based programs, mass media programs achieve effects that are modest in terms of the percentage of smokers who quit (Flay, 1987), but that are quite substantial when one considers the numbers of smokers they may reach. The pattern of results from mass media approaches to smoking cessation shows a striking parallel to the pattern of results from clinical approaches: the more channels of influence that support cessation, the greater the impact (Kottke et al., 1988). Thus, televised programs achieve greater impacts when they are accompanied by printed materials distributed to viewers (Flay, 1987; Warnecke et al., 1992) or by group activities that provide local support for cessation (Flay, 1987; Korhonen et al., 1992).
The National Cancer Institute sponsored the Community Intervention Trial for Smoking Cessation (COMMIT), a large clinical trial that evaluated community-based programs for smoking cessation. COMMIT achieved appreciable impacts among light and moderate smokers but did not significantly increase smoking cessation among heavy smokers (Lichtenstein et al., 1995). The COMMIT program centered on a set of activities and curricula developed centrally and implemented through communities. Community involvement and ownership of the activities occurred through community boards with representatives from major community sectors such as media, health care, and education. This approach, in which the program was implemented through community boards, can be differentiated from approaches that place priority on the authority of community-based organization leadership to plan and direct programs (Fisher, 1995).