Home Health Evaluation of health promotion and disease prevention programs : improving population health through evidence-based practice
When the project began, over 13 million Americans over age 50 smoked. Approximately 32% of men aged 50-74 were smokers: 27% of the women in the same age range smoked. This group of smokers had for the most part smoked for many decades, some for more than 50 years. Most smoked heavily and were highly addicted to nicotine. Many began smoking when it was considered a glamorous part of the American social culture—long before its health consequences were well known.
An evaluation of the environment revealed two significant issues. First, there was a lack of targeted smoking cessation programs and related materials for midlife and older smokers. Second, there was a lack of no-smoking policies in community dwellings for older citizens. The lack of available targeted cessation materials, combined with the absence of no-smoking policies, contributed to the continuation of the smoking behavior among older citizens.
Focus groups with 61 older smokers with a diverse socio-demographic composition recruited from communities and worksites in the Philadelphia, Pennsylvania, area specifically included questions on predisposing, reinforcing, and enabling factors. The participants were equally divided by gender and between midlife (50-64 years of age) and older (65 years and older) adults. Only 22% had a high school education and one-fourth were minorities, predominately African American.
A facilitator’s guide was written, to ensure consistency among the groups, with targeted questions designed to test older participants’ positions on these variables and how they affected their smoking behavior. Topics included positive and negative aspects of smoking, attitudes toward quitting, personal experiences with quitting, and reactions to specific smoking cessation programs and methods. Also, focus group participants responded to a structured questionnaire prior to group discussions. The survey form included items on smoking behavior, motivation to quit, sources of health information, program preferences, and socio-demographics. This tool produced key background information on participants. It served as a pretest for a large mailed survey among older smokers identified by the American Association of Retired Persons.
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