The Equity Impact of Proactive Outreach to Smokers: Analysis of a Randomized Trial

Elizabeth R Danan, Steven S Fu, Barbara A Clothier, Siamak Noorbaloochi, Patrick J. Hammett, Rachel L Widome, Diana J Burgess

Research output: Contribution to journalArticle

2 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)506-516
Number of pages11
JournalAmerican journal of preventive medicine
Volume55
Issue number4
DOIs
StatePublished - Oct 2018

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Smoking Cessation
Education
Telephone
Veterans
Population
Multicenter Studies
Tobacco
Counseling
Logistic Models
Costs and Cost Analysis
Therapeutics

PubMed: MeSH publication types

  • Journal Article
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

Cite this

The Equity Impact of Proactive Outreach to Smokers : Analysis of a Randomized Trial. / Danan, Elizabeth R; Fu, Steven S; Clothier, Barbara A; Noorbaloochi, Siamak; Hammett, Patrick J.; Widome, Rachel L; Burgess, Diana J.

In: American journal of preventive medicine, Vol. 55, No. 4, 10.2018, p. 506-516.

Research output: Contribution to journalArticle

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title = "The Equity Impact of Proactive Outreach to Smokers: Analysis of a Randomized Trial",
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.",
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