1. The Equity Impact of Proactive Outreach to Smokers: Analysis of a Randomized Trial.
- Author
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Danan ER, Fu SS, Clothier BA, Noorbaloochi S, Hammett PJ, Widome R, and Burgess DJ
- Subjects
- Female, Humans, Male, Middle Aged, Multicenter Studies as Topic methods, Randomized Controlled Trials as Topic methods, Smoking psychology, Telephone, United States, United States Department of Veterans Affairs, Veterans psychology, Counseling methods, Smoking therapy, Smoking Cessation psychology, Socioeconomic Factors, Veterans statistics & numerical data
- Abstract
Introduction: Population-based smoking-cessation services tend to preferentially benefit high-SES smokers, potentially exacerbating disparities. Interventions that include proactive outreach, telephone counseling, and free or low-cost cessation medications may be more likely to help low-SES smokers quit. This analysis evaluated the role of SES in smokers' response to a population-based proactive smoking-cessation intervention., Methods: This study, conducted in 2016 and 2017, was a secondary analysis of the Veterans Victory Over Tobacco Study, a multicenter pragmatic RCT of a proactive smoking-cessation intervention conducted from 2009 to 2011. Logistic regression modeling was used to test the effect of income or education level on 6-month prolonged abstinence at 1-year follow-up., Results: Of the 5,123 eligible, randomized participants, 2,565 (50%) reported their education level and 2,430 (47%) reported their income level. The interactions between education (p=0.07) or income (p=0.74) X treatment arm were not statistically significant at the 0.05 level. The largest effect sizes for the intervention were found among smokers in the lowest education category (≤11th grade), with a quit rate of 17.3% as compared with 5.7% in usual care (OR=3.5, 95% CI=1.4, 8.6) and in the lowest income range (<$10,000), with a quit rate of 18.7% as compared with 9.4% in usual care (OR=2.2, 95% CI=1.2, 4.0)., Conclusions: In a large, multicenter smoking-cessation trial, proactive outreach was associated with higher rates of prolonged abstinence among smokers at all SES levels. Proactive outreach interventions that integrate telephone-based care and facilitated cessation medication access have the potential to reduce socioeconomic disparities in quitting., Trial Registration: This study is registered at www.clinicaltrials.gov NCT00608426., (Published by Elsevier Inc.)
- Published
- 2018
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