Proactive tobacco treatment offering free nicotine replacement therapy and telephone counselling for socioeconomically disadvantaged smokers: A randomised clinical trial

Steven S. Fu, Michelle van Ryn, David Nelson, Diana J. Burgess, Janet L. Thomas, Jessie Saul, Barbara Clothier, John A. Nyman, Patrick Hammett, Anne M. Joseph

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background: Evidenced-based tobacco cessation treatments are underused, especially by socioeconomically disadvantaged smokers. This contributes to widening socioeconomic disparities in tobacco-related morbidity and mortality. Methods: The Offering Proactive Treatment Intervention trial tested the effects of a proactive outreach tobacco treatment intervention on population-level smoking abstinence and tobacco treatment use among a population-based sample of socioeconomically disadvantaged smokers. Current smokers (n=2406), regardless of interest in quitting, who were enrolled in the Minnesota Health Care Programs, the state's publicly funded healthcare programmes for low-income populations, were randomly assigned to proactive outreach or usual care. The intervention comprised proactive outreach (tailored mailings and telephone calls) and free cessation treatment (nicotine replacement therapy and intensive, telephone counselling). Usual care comprised access to a primary care physician, insurance coverage of Food and Drug Administration-approved smoking cessation medications, and the state's telephone quitline. The primary outcome was self-reported 6-month prolonged smoking abstinence at 1 year and was assessed by follow-up survey. Findings: The proactive intervention group had a higher prolonged abstinence rate at 1 year than usual care (16.5% vs 12.1%, OR 1.47, 95% CI 1.12 to 1.93). The effect of the proactive intervention on prolonged abstinence persisted in selection models accounting for non-response. In analysis of secondary outcomes, use of evidence-based tobacco cessation treatments were significantly greater among proactive outreach participants compared with usual care, particularly combination counselling and medications (17.4% vs 3.6%, OR 5.69, 95% CI 3.85 to 8.40). Interpretation: Population-based proactive tobacco treatment increases engagement in evidence-based treatment and is effective in long-term smoking cessation among socioeconomically disadvantaged smokers. Findings suggest that dissemination of population-based proactive treatment approaches is an effective strategy to reduce the prevalence of smoking and socioeconomic disparities in tobacco use.

Original languageEnglish (US)
Pages (from-to)446-453
Number of pages8
JournalThorax
Volume71
Issue number5
DOIs
StatePublished - May 1 2016
Externally publishedYes

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Vulnerable Populations
Nicotine
Telephone
Tobacco
Counseling
Randomized Controlled Trials
Withholding Treatment
Tobacco Use Cessation
Smoking
Tobacco Use
Smoking Cessation
Therapeutics
Population
Delivery of Health Care
Insurance Coverage
Primary Care Physicians
United States Food and Drug Administration
Poverty
Morbidity
Mortality

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Proactive tobacco treatment offering free nicotine replacement therapy and telephone counselling for socioeconomically disadvantaged smokers : A randomised clinical trial. / Fu, Steven S.; van Ryn, Michelle; Nelson, David; Burgess, Diana J.; Thomas, Janet L.; Saul, Jessie; Clothier, Barbara; Nyman, John A.; Hammett, Patrick; Joseph, Anne M.

In: Thorax, Vol. 71, No. 5, 01.05.2016, p. 446-453.

Research output: Contribution to journalArticle

Fu, Steven S. ; van Ryn, Michelle ; Nelson, David ; Burgess, Diana J. ; Thomas, Janet L. ; Saul, Jessie ; Clothier, Barbara ; Nyman, John A. ; Hammett, Patrick ; Joseph, Anne M. / Proactive tobacco treatment offering free nicotine replacement therapy and telephone counselling for socioeconomically disadvantaged smokers : A randomised clinical trial. In: Thorax. 2016 ; Vol. 71, No. 5. pp. 446-453.
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abstract = "Background: Evidenced-based tobacco cessation treatments are underused, especially by socioeconomically disadvantaged smokers. This contributes to widening socioeconomic disparities in tobacco-related morbidity and mortality. Methods: The Offering Proactive Treatment Intervention trial tested the effects of a proactive outreach tobacco treatment intervention on population-level smoking abstinence and tobacco treatment use among a population-based sample of socioeconomically disadvantaged smokers. Current smokers (n=2406), regardless of interest in quitting, who were enrolled in the Minnesota Health Care Programs, the state's publicly funded healthcare programmes for low-income populations, were randomly assigned to proactive outreach or usual care. The intervention comprised proactive outreach (tailored mailings and telephone calls) and free cessation treatment (nicotine replacement therapy and intensive, telephone counselling). Usual care comprised access to a primary care physician, insurance coverage of Food and Drug Administration-approved smoking cessation medications, and the state's telephone quitline. The primary outcome was self-reported 6-month prolonged smoking abstinence at 1 year and was assessed by follow-up survey. Findings: The proactive intervention group had a higher prolonged abstinence rate at 1 year than usual care (16.5{\%} vs 12.1{\%}, OR 1.47, 95{\%} CI 1.12 to 1.93). The effect of the proactive intervention on prolonged abstinence persisted in selection models accounting for non-response. In analysis of secondary outcomes, use of evidence-based tobacco cessation treatments were significantly greater among proactive outreach participants compared with usual care, particularly combination counselling and medications (17.4{\%} vs 3.6{\%}, OR 5.69, 95{\%} CI 3.85 to 8.40). Interpretation: Population-based proactive tobacco treatment increases engagement in evidence-based treatment and is effective in long-term smoking cessation among socioeconomically disadvantaged smokers. Findings suggest that dissemination of population-based proactive treatment approaches is an effective strategy to reduce the prevalence of smoking and socioeconomic disparities in tobacco use.",
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AU - Thomas, Janet L.

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AU - Nyman, John A.

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