Smoking in the U.S. follows a clear socio-economic gradient: low-income Americans
smoke more and quit less than those with more education and income. Evidence-based
interventions like tobacco quitlines are designed to make effective smoking cessation
services available on a population basis to all smokers, regardless of financial means.
Yet these interventions were not designed specifically for economically vulnerable
populations, and therefore don't address many of the unique challenges faced by low-
income smokers. As the demographics of smoking in the U.S. continue to shift, so too
must the strategies employed to control smoking, including helping smokers quit.
The proposed study will test the effects of two innovations to help low-income smokers
quit: a Specialized Quitline and Basic Needs navigation. In low-income populations,
basic needs like food, housing, personal safety and money for necessities supersede
health needs. We have demonstrated that among low-income smokers, those with
multiple unmet basic needs are significantly less likely to contact a quitline referral they
received, and less likely to remember even getting the referral. But when basic needs
problems are resolved, the odds of calling a quitline increase. Addressing basic needs
should therefore increase low-income smokers' participation in quit smoking programs.
However, those programs will have limited effectiveness if they are not made relevant to
economically vulnerable populations. Thus proven approaches like quitlines should be
more beneficial when they are adapted to the context and life circumstances of the poor.
Using a 2x2 randomized factorial design, we will compare the effects of Standard and
Specialized Quitlines with and without a Basic Needs navigator on smoking cessation
among 2000 low-income smokers. The primary study outcome is self-reported 7-day
point prevalence abstinence at 6-month follow up, with biochemical validation. This
statewide field trial will draw smokers from United Way 2-1-1 Missouri and refer them to
the Missouri Tobacco Quitline, provided by Alere Wellbeing, Inc. Both are key members
of the study team. Embedding the study in these practice agencies will accelerate the
path to application should our findings support it.
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