University of Kentucky UKnowledge Theses and Dissertations--Clinical and Translational Science Behavioral Science 2019 A PILOT STUDY OF A MULTIPLE HEALTH BEHAVIOR CHANGE INTERVENTION FOR SMOKERS Srihari Seshadri University of Kentucky, [email protected] Author ORCID Identifier: https://orcid.org/0000-0002-0540-4843 Digital Object Identifier: https://doi.org/10.13023/etd.2019.303 Right click to open a feedback form in a new tab to let us know how this document benefits ou.y Recommended Citation Seshadri, Srihari, "A PILOT STUDY OF A MULTIPLE HEALTH BEHAVIOR CHANGE INTERVENTION FOR SMOKERS" (2019). Theses and Dissertations--Clinical and Translational Science. 10. https://uknowledge.uky.edu/cts_etds/10 This Doctoral Dissertation is brought to you for free and open access by the Behavioral Science at UKnowledge. It has been accepted for inclusion in Theses and Dissertations--Clinical and Translational Science by an authorized administrator of UKnowledge. For more information, please contact [email protected]. STUDENT AGREEMENT: I represent that my thesis or dissertation and abstract are my original work. Proper attribution has been given to all outside sources. I understand that I am solely responsible for obtaining any needed copyright permissions. I have obtained needed written permission statement(s) from the owner(s) of each third-party copyrighted matter to be included in my work, allowing electronic distribution (if such use is not permitted by the fair use doctrine) which will be submitted to UKnowledge as Additional File. I hereby grant to The University of Kentucky and its agents the irrevocable, non-exclusive, and royalty-free license to archive and make accessible my work in whole or in part in all forms of media, now or hereafter known. I agree that the document mentioned above may be made available immediately for worldwide access unless an embargo applies. I retain all other ownership rights to the copyright of my work. I also retain the right to use in future works (such as articles or books) all or part of my work. I understand that I am free to register the copyright to my work. REVIEW, APPROVAL AND ACCEPTANCE The document mentioned above has been reviewed and accepted by the student’s advisor, on behalf of the advisory committee, and by the Director of Graduate Studies (DGS), on behalf of the program; we verify that this is the final, approved version of the student’s thesis including all changes required by the advisory committee. The undersigned agree to abide by the statements above. Srihari Seshadri, Student Dr. Nancy E. Schoenberg, Major Professor Dr. Claire D. Clark, Director of Graduate Studies A PILOT STUDY OF A MULTIPLE HEALTH BEHAVIOR CHANGE INTERVENTION FOR SMOKERS ________________________________________ DISSERTATION ________________________________________ A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the College of Medicine at the University of Kentucky By Srihari Seshadri Lexington, Kentucky Director: Nancy E. Schoenberg, PhD, Marion Pearsall Professor of Behavioral Science Lexington, Kentucky 2019 Copyright © Srihari Seshadri 2019 https://orcid.org/0000-0002-0540-4843 ABSTRACT OF DISSERTATION A PILOT STUDY OF A MULTIPLE HEALTH BEHAVIOR CHANGE INTERVENTION FOR SMOKERS Background: Being both obese and a smoker increases the probability of developing type 2 diabetes, cardiovascular disease, and cancer, diseases that impact Kentucky residents disproportionately. Kentucky (KY) has a high incidence of obesity (34.2%) and smoking (24.5 %). Weight gain associated with smoking cessation also can undermine health benefits of quitting, and may lead to smoking relapse. Aim: The aim of the pilot study was to implement and evaluate a Multiple Health Behavioral Change (MHBC) program that combines Cooper Clayton Method to Stop Smoking (CCMSS) and the Diabetes Prevention Program (DPP) for weight control. Method: A 15-week intervention was administered in Appalachian (Perry County/Hazard, KY) and non-Appalachian (Warren County/Bowling Green, KY) counties. Baseline assessments consisted of height, weight, waist circumference, and breathe carbon monoxide level. Approximately one week after baseline assessment, participants attended weekly classes. During the initial 3 weeks, the CCMSS was administered. At week 4, facilitators introduced a modified 12-week DPP phase of the program concurrently with CCMSS sessions. Posttest assessment included participation feedback and a repeated assessment. Result: Seven (31.8%) of the 22 participants who attended at least one session quit smoking. At the posttest assessment session of the MHBC program 6 participants remained abstinent and experienced an average weight gain of 4.5lbs (-8lbs. to 11.4 lbs.) and 0.4-inch decrease in waist circumference (-4.5 to 1 inch). Discussion: Recruitment was successful; however, participant retention fell short of expectations, therefore the program lacked feasibility. Poor retention is not surprising, given the duration of the intervention as well as the challenge of an intervention that addresses two of our most difficult health behavior changes of weight control and smoking. All seven participants who successfully completed the program expressed a high degree of satisfaction. Four participants indeed expressed that the combined challenge had been overwhelming and that they needed a support group to maintain a non-smoking status. KEYWORDS: Multiple Health Behavior Change, Pilot Study, Smoking Cessation, Weight Control, Cooper Clayton Method to Stop Smoking, Diabetes Prevention Program Srihari Seshadri (Name of Student) 07/11/2019 Date A PILOT STUDY OF A MULTIPLE HEALTH BEHAVIOR CHANGE INTERVENTION FOR SMOKERS By Srihari Seshadri Nancy E. Schoenberg, Ph.D. Director of Dissertation Claire D. Clark, Ph.D., MPH Director of Graduate Studies 07/11/2019 Date DEDICATION To My Community ACKNOWLEDGMENTS The following dissertation, while an individual work, benefited from the insights, support, encouragement and direction of several people. First, my Dissertation Chair, Dr. Nancy E. Schoenberg, exemplifies the high quality scholarship and dedication to research to which I aspire. She provided timely and instructive comments and evaluation at every stage of the dissertation process, allowing me to complete this project. Next, I wish to thank the complete Dissertation Committee: Dr. Jamie Studts, Dr. Brady Reynolds, and Dr. Steve Browning. Each one of them provided insights that guided and challenged my thinking, substantially improving the finished product. I also need to thank Dr. Thomas Kelly for his guidance and help throughout the program. Special thanks to Department of Medical Behavioral Science faculty and staff. In addition to the technical and instrumental assistance above, I received equally important on-going support from my family and friends. My good friend, well-wisher and former colleague Ms. Elizabeth Siddens provided on-going support and encouragement throughout my PhD program including but not limited to editing/proofing my dissertation. I honestly would not have been able to complete this dissertation without her help. I could not have done my research project without the help of numerous former colleagues/work family at Barren River District Health Department in Bowling Green, KY: our Cooper Clayton Method to Stop Smoking (CCMSS) facilitators Ms. Joyce Adkins and Carol Douglas; and our Diabetes Prevention Program (DPP) facilitator Ms. Megan Givan. Special thanks to Mr. Dennis R. Chaney, Ms. Crissy Rowland, Ms. Diane Sprowl and Ms. Lisa Houchin, for encouraging and supporting us to conduct this research project in the Barren River iii District. I need to specially thank Ms. Beth Bowling, Rural Project Manager, UK Center of Excellence in Rural Health, for serving as the backbone of this study at the Little Flower Clinic in Hazard, KY. A hearty shout out to AmeriCorps Vista workers Ms. Aly Cooper and Ms. Kathryn Beach for facilitating both the CCMSS and DPP curriculum at the Little Flower Clinic. Special thanks to the Little Flower Clinic, Hazard, KY and the Foundry Christian Community Center, Bowling Green, KY for allowing us to use their facility to conduct this research project. I am sure I have left out several people who helped me through my PhD journey – my hearty thanks to them as well. I certainly thank the participants of my study (who remain anonymous for confidentiality purposes), and wish each of them success in their health improvement efforts. My most important acknowledgement goes to my parents, Seshadri and Nagamani, wife, Jayashree, and daughter, Shriya. Their understanding, patience and flexibility have been critical to my pursuit of education, and their loving support is my ongoing source of happiness. iv TABLE OF CONTENTS ACKNOWLEDGMENTS ........................................................................................................................... iii LIST OF TABLES ..................................................................................................................................... vii LIST OF FIGURES .................................................................................................................................. viii CHAPTER 1. INTRODUCTION ................................................................................................................. 1 1.1 Health Risks of Tobacco Use and Obesity ........................................................................................ 1 1.2 Appalachian