Lead/Presenter: Diana Burgess, COIN - Minneapolis
All Authors: Danan ER (HSR&D CCDOR, Minneapolis; University of Minnesota Medical School)
Fu SS (CCDOR, Minneapolis; University of Minnesota Medical School)
Clothier BA (CCDOR, Minneapolis)
Noorbaloochi S (CCDOR, Minneapolis; University of Minnesota Medical School)
Hammett PJ (CCDOR, Minneapolis; University of Minnesota School of Public Health)
Widome R (University of Minnesota School of Public Health)
Burgess DJ (CCDOR, Minneapolis; University of Minnesota Medical School)
Objectives:
To evaluate the role of socioeconomic status (SES) in smokers' response to a population-based proactive smoking cessation intervention.
Methods:
We performed a secondary analysis of the Veterans Victory Over Tobacco Study, a two-arm multicenter randomized controlled trial of a proactive smoking cessation intervention versus usual care. The intervention included telephone outreach, motivational interviewing, and facilitated medication access. Self-reported income and education were used to characterize SES. The primary outcome was self-reported 6-month prolonged abstinence at one-year follow-up. We tested the effect of income and education level on abstinence and evaluated whether the intervention was differentially associated with abstinence for people at lower or higher SES levels.
Results:
Of the 5,123 eligible, randomized participants, 2,430 (43%) provided an income level and 2,565 (50%) provided an education level. The interactions between income and treatment arm (p = 0.74) and between education and treatment arm (p = 0.07) were not statistically significant at the 0.05 level. In subgroup analyses, the proactive intervention had the largest effect among smokers in the lowest income range ( < $10k), with a quit rate of 17.7% compared to 8.8% in usual care (OR, 2.2 [95% CI, 1.2-4.0]). The proactive intervention also had the largest effect among smokers in the lowest education category ( < 11th grade), with a quit rate of 16.4% compared to 5.3% in usual care (OR, 3.5 [95% CI, 1.4-8.6]).
Implications:
In a large, multicenter VA smoking cessation trial, a proactive care intervention was associated with higher rates of prolonged abstinence among smokers at all income and education levels. The largest effects were seen among smokers at the lowest income and education levels, who are historically the least likely to quit successfully. Motivational interviewing, telephone outreach and facilitated medication access, which were all elements of the proactive intervention, may help low SES smokers overcome barriers to quitting.
Impacts:
SES is a fundamental cause of smoking-related health disparities: low SES is associated with a greater likelihood of being a smoker, heavier use of cigarettes, less successful quitting, even when using standard cessation services, and higher smoking-related morbidity. Traditional smoking cessation services tend to preferentially benefit advantaged smokers, potentially exacerbating disparities. Our findings demonstrate one strategy for reducing smoking-related disparities.