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Proactive tobacco cessation outreach to smokers of low socioeconomic status: a randomized clinical trial.
JAMA Intern Med. 2015 Feb; 175(2):218-26.JIM

Abstract

IMPORTANCE

Widening socioeconomic disparities in mortality in the United States are largely explained by slower declines in tobacco use among smokers of low socioeconomic status (SES) than among those of higher SES, which points to the need for targeted tobacco cessation interventions. Documentation of smoking status in electronic health records (EHRs) provides the tools for health systems to proactively offer tobacco treatment to socioeconomically disadvantaged smokers.

OBJECTIVE

To evaluate a proactive tobacco cessation strategy that addresses sociocontextual mediators of tobacco use for low-SES smokers.

DESIGN, SETTING, AND PARTICIPANTS

This prospective, randomized clinical trial included low-SES adult smokers who described their race and/or ethnicity as black, Hispanic, or white and received primary care at 1 of 13 practices in the greater Boston area (intervention group, n = 399; control group, n = 308).

INTERVENTIONS

We analyzed EHRs to identify potentially eligible participants and then used interactive voice response (IVR) techniques to reach out to them. Consenting patients were randomized to either receive usual care from their own health care team or enter an intervention program that included (1) telephone-based motivational counseling, (2) free nicotine replacement therapy (NRT) for 6 weeks, (3) access to community-based referrals to address sociocontextual mediators of tobacco use, and (4) integration of all these components into their normal health care through the EHR system.

MAIN OUTCOMES AND MEASURES

Self-reported past-7-day tobacco abstinence 9 months after randomization ("quitting"), assessed by automated caller or blinded study staff.

RESULTS

The intervention group had a higher quit rate than the usual care group (17.8% vs 8.1%; odds ratio, 2.5; 95% CI, 1.5-4.0; number needed to treat, 10). We examined whether use of intervention components was associated with quitting among individuals in the intervention group: individuals who participated in the telephone counseling were more likely to quit than those who did not (21.2% vs 10.4%; P < .001). There was no difference in quitting by use of NRT. Quitting did not differ by a request for a community referral, but individuals who used their referral were more likely to quit than those who did not (43.6% vs 15.3%; P < .001).

CONCLUSIONS AND RELEVANCE

Proactive, IVR-facilitated outreach enables engagement with low-SES smokers. Providing counseling, NRT, and access to community-based resources to address sociocontextual mediators among smokers reached in this setting is effective.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01156610.

Authors+Show Affiliations

Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts2Department of Social and Behavior Sciences, Harvard School of Public Health, Boston, Massachusetts3Harvard Medical School, Boston, Massachusetts.Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts3Harvard Medical School, Boston, Massachusetts.Harvard Medical School, Boston, Massachusetts4Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston5Division of General Internal Medicine, Massachusetts General Hospital, Boston.Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.Harvard Medical School, Boston, Massachusetts4Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston5Division of General Internal Medicine, Massachusetts General Hospital, Boston.Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.Department of Social and Behavior Sciences, Harvard School of Public Health, Boston, Massachusetts.Harvard Medical School, Boston, Massachusetts.Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.Harvard Medical School, Boston, Massachusetts6Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.Department of Social and Behavior Sciences, Harvard School of Public Health, Boston, Massachusetts.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25506771

Citation

Haas, Jennifer S., et al. "Proactive Tobacco Cessation Outreach to Smokers of Low Socioeconomic Status: a Randomized Clinical Trial." JAMA Internal Medicine, vol. 175, no. 2, 2015, pp. 218-26.
Haas JS, Linder JA, Park ER, et al. Proactive tobacco cessation outreach to smokers of low socioeconomic status: a randomized clinical trial. JAMA Intern Med. 2015;175(2):218-26.
Haas, J. S., Linder, J. A., Park, E. R., Gonzalez, I., Rigotti, N. A., Klinger, E. V., Kontos, E. Z., Zaslavsky, A. M., Brawarsky, P., Marinacci, L. X., St Hubert, S., Fleegler, E. W., & Williams, D. R. (2015). Proactive tobacco cessation outreach to smokers of low socioeconomic status: a randomized clinical trial. JAMA Internal Medicine, 175(2), 218-26. https://doi.org/10.1001/jamainternmed.2014.6674
Haas JS, et al. Proactive Tobacco Cessation Outreach to Smokers of Low Socioeconomic Status: a Randomized Clinical Trial. JAMA Intern Med. 2015;175(2):218-26. PubMed PMID: 25506771.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Proactive tobacco cessation outreach to smokers of low socioeconomic status: a randomized clinical trial. AU - Haas,Jennifer S, AU - Linder,Jeffrey A, AU - Park,Elyse R, AU - Gonzalez,Irina, AU - Rigotti,Nancy A, AU - Klinger,Elissa V, AU - Kontos,Emily Z, AU - Zaslavsky,Alan M, AU - Brawarsky,Phyllis, AU - Marinacci,Lucas X, AU - St Hubert,Stella, AU - Fleegler,Eric W, AU - Williams,David R, PY - 2014/12/16/entrez PY - 2014/12/17/pubmed PY - 2015/4/2/medline SP - 218 EP - 26 JF - JAMA internal medicine JO - JAMA Intern Med VL - 175 IS - 2 N2 - IMPORTANCE: Widening socioeconomic disparities in mortality in the United States are largely explained by slower declines in tobacco use among smokers of low socioeconomic status (SES) than among those of higher SES, which points to the need for targeted tobacco cessation interventions. Documentation of smoking status in electronic health records (EHRs) provides the tools for health systems to proactively offer tobacco treatment to socioeconomically disadvantaged smokers. OBJECTIVE: To evaluate a proactive tobacco cessation strategy that addresses sociocontextual mediators of tobacco use for low-SES smokers. DESIGN, SETTING, AND PARTICIPANTS: This prospective, randomized clinical trial included low-SES adult smokers who described their race and/or ethnicity as black, Hispanic, or white and received primary care at 1 of 13 practices in the greater Boston area (intervention group, n = 399; control group, n = 308). INTERVENTIONS: We analyzed EHRs to identify potentially eligible participants and then used interactive voice response (IVR) techniques to reach out to them. Consenting patients were randomized to either receive usual care from their own health care team or enter an intervention program that included (1) telephone-based motivational counseling, (2) free nicotine replacement therapy (NRT) for 6 weeks, (3) access to community-based referrals to address sociocontextual mediators of tobacco use, and (4) integration of all these components into their normal health care through the EHR system. MAIN OUTCOMES AND MEASURES: Self-reported past-7-day tobacco abstinence 9 months after randomization ("quitting"), assessed by automated caller or blinded study staff. RESULTS: The intervention group had a higher quit rate than the usual care group (17.8% vs 8.1%; odds ratio, 2.5; 95% CI, 1.5-4.0; number needed to treat, 10). We examined whether use of intervention components was associated with quitting among individuals in the intervention group: individuals who participated in the telephone counseling were more likely to quit than those who did not (21.2% vs 10.4%; P < .001). There was no difference in quitting by use of NRT. Quitting did not differ by a request for a community referral, but individuals who used their referral were more likely to quit than those who did not (43.6% vs 15.3%; P < .001). CONCLUSIONS AND RELEVANCE: Proactive, IVR-facilitated outreach enables engagement with low-SES smokers. Providing counseling, NRT, and access to community-based resources to address sociocontextual mediators among smokers reached in this setting is effective. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01156610. SN - 2168-6114 UR - https://www.unboundmedicine.com/medline/citation/25506771/Proactive_tobacco_cessation_outreach_to_smokers_of_low_socioeconomic_status:_a_randomized_clinical_trial_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2014.6674 DB - PRIME DP - Unbound Medicine ER -