Helping the Poor Quit Smoking: Specialized Quitlines and Meeting Basic Needs

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Project Summary/Abstract The impact of COVID-19 on low-income and minority populations has been profound, spanning health, employment, income, food, rent, transportation and daily needs like diapers and toilet paper. In Missouri, where the parent study and proposed supplement take place, disparities abound. African Americans make up <12% of the state population but over 40% of COVID-19 deaths – the second largest gap in the U.S. among states reporting race data. As of April 20, 2020, we have enrolled 1,743 low-income daily smokers in the parent study, a randomized trial testing two cessation interventions. Over half report annual household income <$10,000, most (59%) are African American, and many (30%) did not complete high school. They are also sick: 50% report at least one chronic condition (28% asthma, 20% COPD, 15% Type II diabetes, 10% heart disease), and 56% rate their health as “fair” (39%) or “poor” (17%). From March 9 to April 16, 2020, we administered COVID-19 survey items to 88 participants. Awareness of COVID-19 was high, but protective behaviors were inconsistent, and occupational exposures were high: of those who worked – 74% African Americans – only 19% had been off work and 6% worked from home during COVID. In short, low-wage minority smokers, often in fair or poor health, were working outside the home, having more contact with others, but with little protective equipment. We propose a highly innovative study in this sub-group using intensive longitudinal data collection and cutting-edge time series analyses to understand complex, dynamic relationships among four factors identified as priorities in the RFA: (1) employment disruptions; (2) social and economic needs; (3) adherence to COVID-19 containment and mitigation recommendations; and (4) health indicators and behaviors. The study will produce estimates that can be used to model adherence to protective measures and disruption to daily needs, personal health, and health behaviors such as smoking in low-wage minority workers during pandemics.