A strategy that relied on electronic health records (EHRs) to identify smokers and interactive voice-response telephone calls to reach them may help promote tobacco cessation efforts among smokers of low-socioeconomic status (SES), according to a report published online by JAMA Internal Medicine.
Tobacco use in the United States has declined but socioeconomic, racial and ethnic disparities remain in smoking prevalence and tobacco-related disease. While smokers visit primary care clinicians (PCCs), PCCs often do not have adequate time or training to provide tobacco treatment. EHRs coded with data about smoking status are an important tool to help reach out to smokers. Few clinical trials have examined smoking cessation interventions in low-SES populations, according to background information in the study.
Jennifer S. Haas, M.D., M.P.H., of Brigham and Women's Hospital, Boston, and co-authors used a randomized clinical trial that included low-SES adult smokers who received primary care at one of 13 practices in the Boston area. Of the patients who consented to the study, 308 received usual care from their health care team and 399 entered an intervention program that included telephone-based motivational counseling with tobacco treatment specialists (TTS), free nicotine replacement therapy (NRT) for six weeks and community-based referrals to address factors related to tobacco use. The median age of the smokers was 50 years, 68 percent of participants were women and 35 percent had Medicaid.
Results show the intervention group had a higher quit rate (17.8 percent) compared with the usual care group (8.1 percent). Smokers who participated in telephone counseling were more likely to quit than those who did not (21.2 percent vs. 10.4 percent), although there was no difference in quitting by use of NRT. Quitting also did not differ based on request for a community referral but smokers who used their referrals were more likely to quit than those who did not (43.6 percent vs. 15.3 percent). Women, blacks, whites, those participants with more than a high school education and those participants who lived in a low-income census tract (less than $45,000 median household income) were more likely to quit smoking in the intervention than in the control group.
"Project CLIQ (Community Link to Quit) demonstrates that proactive, systematic, telephone-based interventions to provide counseling, pharmacotherapy and access to community-based resources to address the social context of smoking can promote tobacco cessation in disadvantaged populations," the study concludes.
Commentary: Proactive Outreach to Connect Smokers with Cessation Treatment
In a related commentary, Anne Joseph, M.D., M.P.H., of the University of Minnesota, Minneapolis, and Steven Fu, M.D., M.S.C.E, of the Minneapolis Veterans Affairs Health Care System Home, Minneapolis, write: "The focus on dissemination of treatment to engage smokers is a clear strength of this report. Results support continued investigation of new proactive methods to extend treatment to hard-to-reach populations. Importantly, the results challenge assumptions that low-income smokers are not interested in quitting and that treatment is not effective in this population. A population-based approach that extends tobacco dependence treatment to all income groups, all racial and ethnic groups and patients with all comorbidities is the only way to effectively reduce the prevalence of smoking in the United States," the authors conclude.
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