University of Alberta Edmonton, Canada 1 November 1996

Researchers' comic book has meaningful dialogue for smokers

Positive response from smokers, health agencies and researchers

By David Holehouse

Two researchers at the University of Alberta have developed a comic book and teaching manual designed to help "hard to reach" male smokers quit the habit. Health Canada awarded about $75,000 for the project, completed by Maryanne Doherty-Poirier and Brenda Munro of the Department of Human Ecology, in collaboration with Gordon Munro of the Alberta Alcohol and Drug Abuse Commission.

The group conducted a literature review and a needs assessment, which led them to the conclusion that there's a gap in smoking cessation programs directed at hard to reach and hard core smokers, specifically those males who are also dealing with additional addictions to alcohol and other drugs.

"Thirty percent of the Canadian population smokes, but with multiple substance abuse clients, the number is 90 percent," said Gordon Munro. "We know that smoking kills three times more people than alcohol, drugs, crime and AIDS combined, so we asked our clients at Henwood treatment centre if they wanted to quit. We thought perhaps five or 15 percent would say yes, but we found the actual number was 80 percent."

The researchers designed a theoretical model of smoking behaviour and cessation based on states of change identified by J Prochaska and C DiClemente. This assumes the client will progress through a number of stages, from precontemplation and contemplation to preparation, action, maintenance and termination or exit from the cycle of behaviour.

But when it was time to move from theory to a physical product, the researchers decided to ask the smokers what would work best. They were told emphatically that the smokers didn't want traditional brochures or videos or judgmental lectures. When asked what they read, most said they checked the comic strips in the daily papers.

"We did some intensive focus groups with the street guys downtown at the [AADAC] Herb Jamieson Centre," said Dr Poirier-Doherty. "We found they wanted a story line, not just facts and figures, and they wanted characters they could identify with-people with little money, who use their language, who have had some negative experiences in life."

The result is a 16-page comic book called "Bob and Henry: Who Stole My Smokes?" featuring a dedicated smoker and odd-jobber named Bob who starts to notice how his cravings affect his work habits, his pocketbook, his health and his general stress level. With positive support, some alternative behaviours and the inevitable anguish of withdrawal, Bob quits-one day at a time.

Another product of the project is a teaching manual that can be used by counsellors in tandem with the comic book. Both will be used with men in halfway houses and treatment centres after they have stabilized their other addictions. Response so far has been very good, said Dr Poirier-Doherty-both from smokers and from other agencies and researchers across Canada.

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