1. What Smokers Want (focus on blue-collar workers) Elizabeth M. Barbeau, ScD, MPH Dana-Farber Cancer Institute Harvard School of Public Health

2. Data Source Part of large RCT trial to assess efficacy of a combined smoking cessation-diet intervention (Sorensen, PI) Focus groups held around the country in 2001-2002 Sample: n=88; 84% male; 64% white, 15% black, 7% Hispanic, 11% other; 97% had not completed college, 17% did not complete high school; age range 20-63 years, mean of 41 years of age; 78% current smokers

3. Major Thematic Categories Barriers to quitting Attitudes about methods for quitting smoking Experiences with cessation aids

4. Barriers to Quitting Lack of interest in quitting Many friends, family and co-workers smoke Lack of self-efficacy Concerns about weight gain Lack of insurance coverage Fear of experiencing withdrawal symptoms

5. Attitudes about methods for quitting smoking Commonly-held view that single most important determinant of a successful quit is the strong desire and commitment to quit. “Every time I buy a pack of cigarettes, I’m putting another nail in my coffin…But I feel that if you really want to quit smoking, and you put in your mind to quit, you can do it. Doctors can’t help you. Therapists can’t help you. The patch is not going to help you. The little drops are not going to help you…It’s another form of (...inaudible) throwing you back. It’s not going to help you. You’ve got to decide that. If you’re not willing to do it, it ain’t going to work.” (54 year old African American male, smoker)

6. Attitudes about methods for quitting smoking (cont’d) Lack of awareness of what is available Some serious misconceptions about cessation aids –“That nicotine Patch, it can cause as much harm to you as that cigarette.” (Facilitator notes that smoking while wearing the patch can be harmful) –“And, not just with the smoking. The patch. They tell you it’s one thing, and it could be something else in there. It can cause cancer, too.” (41 year old African American female, smoker)

7. Attitudes about methods for quitting smoking (cont’d) Tom (39 year old white male): “I’ve never tried the patches before, but some of the guys I know have tried and they said they smoked with the patches. It gave them such a rush.” Mary (30-ish white female): “I didn’t. The gum made me sick.” Tom: “If I knew there was something that could make me quit. I mean a pill, or anything at all.” Jane (27 year old white female): “Or an inhalant.” Mary: “The pill increases your risk of heart attacks.” Jane: “Yeah but didn’t they recall that. Something was wrong with that.”

8. Experiences with cessation aids Many participants mentioned use of the nicotine patch, with mixed reports of success. A few mentioned Zyban, hypnosis, gum, nasal spray None mentioned any form of counseling or quitlines

9. Experiences with nicotine patch “I've done the patch, I can't tell you how many times. And, it's worked for me. And I've scaled down, until I got to the point where I didn't need one at all. Whatever situation may have arose, whether it be a stressful situation, or I was around someone else smoking, and it would start slowly again. I'd smoke five a day, and then half a pack a day. And then before I knew it, I was back to a pack a day. (40 year old white male)

10. Experiences with Zyban “Well, it [Zyban] cut me back quite a bit, and that’s during that bad time in my life. But, when it came down to it, I still wanted to smoke. So I just didn’t quit. And with Zyban, you can smoke and take the Zyban. So it’s not like the nicotine patch or anything like that where you’re going to overdose yourself with the nicotine. Zyban is more or less just anti-depression. That’s all it is.” (41 year old white male)

11. Experiences with several types of cessation aids Many participants had tried several methods of quitting over several different quit attempts Many reported extended abstinence periods of several months to several years, with relapses. “I’ve tried Nicorette, I’ve tried the pill, I’ve tried hypnosis, I’ve tried the patches. — I enjoy smoking. Every one of them worked for a little while. Then it didn’t.”(30-ish year old white female)