Author ORCID Identifier

Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation




Behavioral Science

First Advisor

Dr. Nancy E. Schoenberg


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.

Digital Object Identifier (DOI)

Funding Information

This pilot grant was funded through the Department of Behavioral Science pilot grant program.