Boston, MA-- Although tobacco use in the United States has declined, substantial socioeconomic, racial and ethnic disparities in smoking prevalence remain, particularly among smokers of low socioeconomic (SES) status, who have more difficulty quitting. New research from Brigham and Women's Hospital has now identified effective ways to help this population quit smoking. These findings are published online in JAMA Internal Medicine on December 15, 2014.
"Despite growing disparities in tobacco use and tobacco related disease, few studies have specifically examined smoking interventions in low-SES populations," explained Jennifer S. Haas, MD, MSc, a physician and researcher in the Division of General Medicine and Primary Care at BWH and lead author of this study. "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."
This prospective, randomized clinical trial included low-SES adult smokers who received primary care in the greater Boston area. Low-SES status was defined by living in a census tract with a median household income below the state median, in this case $66,658. The researchers analyzed over 600 electronic health records (EHR) to identify potentially eligible participants and then used interactive voice response (IVR) techniques to reach out to them (i.e. an automated phone call). Consenting participants were randomized to either receive usual care from their own health care team or enter an intervention program that include telephone-based motivational counseling, free nicotine replacement therapy (NRT) for six weeks, access to community-based referrals to address sociocontextual mediators of tobacco use and integration of all these components into their normal care routine through the EHR system.
The researchers found that proactive, IVR-facilitated outreach was an effective way to connect with lower-SES smokers and that providing counseling, NRT and access to community-based resources helped this population quit smoking. The most commonly requested referrals to community resources included those for physical activity, educational opportunities and job counseling. Individuals who reported using their referral for the community resource were 43.6 percent more likely to quit smoking, versus 15.3 percent of people who did not use this referral.
"Our findings demonstrate that this type of proactive outreach to address the social context of smoking can promote tobacco cessation in disadvantaged populations," explained Haas. "Interventions to reduce tobacco use for these populations may reduce disparities in preventable deaths in the U.S., which is an important public health goal."
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This research was conducted with support from the Lung Cancer Disparities Center at the Harvard School of Public Health (funded by National Cancer Institute grant P50 CA148596) and the Harvard Catalyst and from the Harvard Clinical and Translational Science Center (funded by National Institute of Health {NIH} grant 1UL1RR025758-01 and financial contributions from participating institutions).
Brigham and Women's Hospital (BWH) is a 793-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare. BWH has more than 3.5 million annual patient visits, is the largest birthing center in New England and employs nearly 15,000 people. The Brigham's medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in patient care, quality improvement and patient safety initiatives, and its dedication to research, innovation, community engagement and educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, more than 1,000 physician-investigators and renowned biomedical scientists and faculty supported by nearly $650 million in funding. For the last 25 years, BWH ranked second in research funding from the National Institutes of Health (NIH) among independent hospitals. BWH continually pushes the boundaries of medicine, including building on its legacy in transplantation by performing a partial face transplant in 2009 and the nation's first full face transplant in 2011. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information and resources, please visit BWH's online newsroom.
Journal
JAMA Internal Medicine