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Associations between smoking behaviors and financial strain among low-income smokers

Widome RL, Joseph AM, Hammett PJ, Nelson DB, McAlpine D, VanRyn M, Nyman J, Fu SS. Associations between smoking behaviors and financial strain among low-income smokers. Paper presented at: Society for Research on Nicotine and Tobacco Annual Conference; 2015 Feb 27; Philadelphia, PA.




Abstract:

Background Smoking prevalence and tobacco-related disease burden are high among low-income populations. Low-income smokers are less likely to use evidenced-based cessation treatments, especially treatments combining pharmacotherapy and behavioral counseling. Methods We conducted a randomized controlled trial of the effects of a proactive intervention on population-level abstinence and tobacco treatment utilization in low-income smokers. We randomized 2406 smokers (aged 18-64), enrolled in the Minnesota Health Care Programs (MHCP) for low-income persons, to proactive outreach or usual care. Randomization was stratified by MHCP program, age, and sex. The intervention proactively contacted smokers (mailed invitations and telephone calls containing targeted health messages) and provided free cessation treatment comprising NRT and intensive, telephone-based counseling. MHCP enrollees in the usual care arm had coverage for smoking cessation medications. Baseline MHCP administrative and participant survey data were collected prior to randomization. One year post-randomization data were collected via survey of all randomized individuals, regardless of treatment participation, and MHCP data. The primary outcome was six-month prolonged abstinence at one year. Secondary outcomes included short-term abstinence and treatment utilization. Results We identified 2406 smokers among 9362 respondents to our baseline MHCP enrollee survey who were then randomized to condition. Among the sample, 69% of the intervention arm and 78% of the usual care arm completed the follow-up survey. Among proactive outreach participants, 24% engaged in telephone counseling. The prolonged abstinence rate was 16.5% in the intervention arm and 12.1% in usual care. A stratified logistic regression estimated a prolonged abstinence odds ratio of 1.47 (95% CI, 1.12-1.93, p = .006) for proactive outreach. Conclusions We observed a 24% treatment engagement rate with proactive outreach. Moreover, proactive outreach led to greater rates of prolonged abstinence compared to usual care. Results suggest dissemination of proactive treatment approaches may reduce tobacco-related health burdens for low-income smokers.





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