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.
Bibliographical noteFunding Information:
This study was funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, and Health Services Research and Development (IAB-05-303).
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. government. This study was funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, and Health Services Research and Development (IAB-05-303). ED collaborated on the conceptualization of this study, guided the analytic approach, interpreted the results, and wrote most sections of the draft manuscript. She oversaw all aspects of this study and takes full and final responsibility for the paper. SF secured funding for and designed the original Victory trial and collaborated on the conceptualization of the current analysis. SN and BC designed and carried out the statistical analysis and assisted with interpretation and wrote sections of the methods and results. RW and PH collaborated on the conceptualization of this study, critically revised the manuscript, and read and approved the final submitted version. DB is the senior author on the paper; she led the conceptualization and helped design the analytic approach, interpret the study findings, and revise the manuscript. All authors critically read, provided feedback, and edited the final paper. Registered in clinicaltrials.gov (NCT00608426). Earlier versions of this study were presented in a poster presentation at the Society for Research on Nicotine and Tobacco (Florence, Italy, March 2017); the Society for General Internal Medicine (Washington, DC, April 2017); and the Veterans Affairs Health Services Research and Development National Conference (Washington, DC, July 2017). No financial disclosures were reported by the authors of this paper.
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