Proactive Cessation Programs Effective for Low-Income Smokers

Smoking cessation outreach programs are effective for disadvantaged patient populations, according to research published in the December 15, 2014, edition of JAMA Internal Medicine.

Although there has been a decline in smoking nationwide, researchers from Brigham and Women’s Hospital in Boston noted that smokers with an annual median household income below $66,658 have more difficulty quitting. Therefore, they analyzed the electronic health records (EHRs) of such smokers of low socioeconomic status (SES) in order to identify proactive cessation strategies that address the sociocontextual mediators of tobacco use.

The study included 399 smokers who described their race and/or ethnicity as black, Hispanic, or white, and received primary care at 1 of 13 practices in the Boston area. Patients were randomized to either receive usual care from their own health care team or enter into an intervention program that consisted of telephone-based motivational counseling, free nicotine replacement therapy (NRT) for 6 weeks, access to community-based referrals, and integration of all of those components into their normal care routine through the EHR.

“Despite growing disparities in tobacco use and tobacco -related disease, few studies have specifically examined smoking interventions in low-SES populations,” said leady study author Jennifer S. Haas, MD, MSc, in a press release. “Because of the substantial health burden of tobacco use in these populations, our study developed and evaluated a proactive approach for tobacco treatment that addressed broader socioeconomic mediators of tobacco use.”

While the intervention group had a significantly higher cessation rate than the usual care group, the researchers also examined whether the intervention program’s specific components were more strongly associated with quitting among those included in the study. Individuals who participated in the telephone counseling were more likely to quit smoking than those who did not.

However, there was no difference among patients who used NRT or community referral services. Nevertheless, patients who requested referrals for community resources such as physical activity, educational opportunities, and job counseling were significantly more likely to quit smoking than those who did not.

“Our findings demonstrate that this type of proactive outreach to address the social context of smoking can promote tobacco cessation in disadvantaged populations,” Dr. Haas concluded in the statement. “Interventions to reduce tobacco use for these populations may reduce disparities in preventable deaths in the US, which is an important public health goal.”