Program Eyes How to Make Pigtown Stop Smoking
Morgan State researchers hope engaging the community can help more of it quit
Published: December 28, 2011
The corner stores in Pigtown don’t do “loosies” anymore. Selling cigarettes out of the pack is illegal, and they don’t mess with that (at least not openly). But they do sell ’em by the pack, and the carton, and the mass of signage in their windows makes that plenty clear.
“There’s a bar—you can buy cigarettes there,” says Mary Gunning, pointing toward a corner while walking down West Hamburg Street on a recent weekday morning. “And here’s a corner store—see all the cigarette ads?”
Gunning is the director of St. Jerome’s Head Start, an early childhood education center that serves more than 260 kids from low-income families in Southwest Baltimore. St. Jerome’s focuses on community building and family involvement; as its head, Gunning is an ideal representative for Communities Engaged and Advocating for a Smoke-Free Environment, aka CEASE, a research partnership originating from Morgan State University that’s developing methods of smoking cessation in the neighborhood. Gunning co-chairs CEASE’s Community Action Board (CAB), working with researchers at Morgan to communicate her community’s needs.
Strategies for quitting smoking suffuse the media—use the patch, see your doctor, educate yourself on its dangers. But for reasons that are still unclear, those strategies don’t resonate in Pigtown and other low-income communities. According to Fernando Wagner, a professor at Morgan and the principle researcher for CEASE, a 2002 survey found that 56 percent of Southwest Baltimore residents are smokers; Wagner’s own survey, conducted at a recent Pigtown Festival, found that 42 percent of Pigtown residents smoked, while only 28 percent of those who lived in other parts of the city did.
Pigtown is no stranger to researchers like Wagner. It’s a unique neighborhood—it’s one of 40 in the United States with an equal share of blacks and whites who are equally poor, he says, which is why academics often target it. “When you learn more about health disparities and what causes health disparities, one of the issues that we usually see is that people say, for example, blacks are more likely to use crack,” Wagner notes. “But it is not that they are more likely to use crack because they are black, it is because they are poor and because they live in poor neighborhoods that are disorganized and have a lot of issues. So the issues of socioeconomic characteristics and the neighborhood environment always kind of cloud the relationship between race and other things, and so we wanted to get rid of that so we could really study other determinants that affect health disparities.”
But this time, the research is different. Generally, researchers come in with a question—say, what are the most effective ways to help people quit smoking—recruit participants, do a study, and leave. Wagner and his co-principle researcher, Payam Sheikhattari, an associate professor at Morgan, are trying a method called Community-Based Participatory Research (CPBR)—hence the Community Action Board. As Wagner and Sheikhattari design clinical trials and collect and analyze data, they get feedback from the CAB about what the community wants the research to look like. They train community members to be smoking-cessation facilitators. And when the study is over, and they leave, the idea is for CEASE to be sustainable, able to stand on its own feet and continue to grow as a healthy-living organization, perhaps eventually gaining status as a nonprofit organization.
“Many middle- or upper-class—in socioeconomic terms—people have been able to quit smoking,” Wagner says. “Their smoking rates are very low. There are interventions for people who are middle-class, but there are not as many for people who have low resources. So the challenge was to develop one that would work for them. The only way we thought we could do that was by involving the people who live in the community, learning from their experiences, learning from their points of view, what works with them.”
The way the numbers in Pigtown shake out, it’s clear that the neighborhood has its problems. The Baltimore City Health Department’s 2011 Neighborhood Health Profile of Washington Village/Pigtown found that though the median household income there is slightly higher than that of Baltimore City—$42,504 compared to $37,395—a higher percentage of families were living under the poverty line—20.8 percent in Pigtown to 15.7 percent in the city. And, crucially, out of the 55 areas surveyed, Pigtown ranked 51st for concentration of tobacco outlets: At 50.9 stores per 10,000 residents, Pigtown’s rate is more than double that of the city rate of 21.8.
“In addition to the smoking cessation with the families, we want to look at the larger systems, like how do we reduce the tobacco outlets in this community?” Gunning says. “How can we perhaps initiate or at least support legislation that’s going to be proposed this year around smoking cessation? . . . It’s not just kind of putting the Band-Aid on to get someone to quit smoking. That’s really important, but what are the larger systems?”
Lisa Bleich echoes this sentiment. A facilitator by trade, Bleich’s been working with CEASE for the last three years, ensuring that everything runs smoothly between the researchers and the community and that CEASE will be able to operate after the research period is over. “We’ve discovered you can order a pizza, and there are places that will bring you cigarettes along with your pizza,” Bleich says. “Now, I don’t know where else they do that in Baltimore, but somehow that’s happening here. So that’s one thing where, OK, there’s an opportunity for some policy shifting. The signage for smoking down there is very obvious, because many of these little stores, neighborhood stores, make a lot of their money from having their cigarettes up front.”
And it’s those same corner stores that provide food and groceries to many of Pigtown’s residents on a regular basis. Pigtown has 14.5 corner stores per 10,000 residents; Baltimore City as a whole has 9. The closest full-service grocery store is an eight-minute drive away, more than double the rate in the city. Quitting smoking, then, becomes an issue of support. How do you give up an addiction when you’re surrounded by it?
The answer is becoming a bit clearer. Wagner and Sheikhattari just completed the first phase of their research, in which they studied the differences between one-on-one and group-based smoking interventions, and found that, though it’s early, indications point to successes in both group and one-on-one programs. But there were barriers. Group sessions were held at People’s Community Health Center’s Open Gates location, and many participants didn’t return for a second visit. Few remained for the entire recommended 12 weeks. “People were skeptical or distrustful of the community health center,” Wagner says. “They get bombarded by people running surveys and studies, and they never get anything back, so they are reluctant to participate in this. So the committee decided that probably what we needed to do was to get this program out of the health center and into the community.”
For phase two, the research has shifted to examining what kinds of groups can make the biggest difference. The CAB came up with the idea to train community members as the smoking-cessation facilitators, rather than health care providers. The purpose of this is twofold: make community members feel more comfortable, and begin to build a network that can perform the work once the Morgan researchers leave.
Ask those involved why smoking rates in Pigtown are so high, and plenty of ideas emerge, but no concrete answer. Perhaps its intergenerational. Perhaps it’s the stress of low-income life, or a lack of education, or a combination of things. Darin Wall, program manager and community liaison for CEASE, though, has some thoughts.
“The people in the community tell me they feel like it’s a dumping ground,” Wall says. “Politicians forget about the area. If you feel abandoned, you’re going to turn to things that aren’t necessarily healthy for you, and there are abandonment issues in Southwest Baltimore. You can’t necessarily be healthy if you live in a place that doesn’t reflect that. And if you see the abandoned buildings and you see just how dilapidated the surroundings are, then you’re going to mirror what you see. So what do you do? You drink, you smoke, you break down like the buildings in your neighborhood, and there you are.”
Wall, who comes from a family of active community members, has a personal investment in smoking cessation. His father, Arthur Wall, a former manager for the Department of Social Services and a longtime smoker, died of lung cancer in 2002 at the age of 61. Wall remembers his father being remorseful and apologetic on his deathbed, and it’s that image he uses to motivate himself to motivate others.
“I had several folks come to me basically in tears saying how wonderful it was to have this program,” Wall says. “They can taste food again, they have energy, and they’re excited. How much is a life worth? Is it worth a program where we pay incentives and help folks quit? Yeah, I think so, and I think it’s worth more than that.”
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