Computer expert systems for African–American smokers in physicians offices: A feasibility study

Background. Stage-based computer expert systems (CES), delivered in physician offices, may offer unique opportunities to combine high participation and high efficacy, resulting in a high public health impact. Applying this technology in settings serving low-income African–American smokers, with the addition of practical tools for stress reduction, may help to reduce disparities in morbidity and mortality from smoking-related diseases. Methods. Ninety-eight African–American smokers were recruited from a publicly funded, continuity care clinic waiting room to a study of computer interactive feedback and stress reduction audiotapes. The study was designed to assess: participation and retention rates; acceptability of both the computer expert system and the audiotapes; the fit of the transtheoretical model for the target population; and the 6-month shift in stages of change. Results. Overall, 55.6% of invited smokers participated, 75.5% were seen at all three observation points. The CES and the audiotape were rated as highly interesting, relevant, and new, and most participants tried them. The predictable relationship between stage and decisional balance was reproduced in this low income African–American population. Significant stage progression occurred from baseline to 3 months (P = 0.011), from 3 to 6 months (P = 0.0001), and from baseline to 6 months (P = 0.0001). Conclusions. These data support the feasibility, acceptability and potential efficacy of stage-tailored computer interactive feedback plus stress reduction intervention delivered at the point of service to low-income African–Americans.