Treatment modality and socioeconomic status in treating tobacco dependence

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DESCRIPTION (provided by applicant): PROJECT SUMMARY/ABSTRACT Lower socioeconomic status (SES) and rural groups are overrepresented among smokers and suffer disproportionately from tobacco-related diseases. Arkansas has a high proportion of lower SES and rural residents and one of the highest rates of smoking in the nation. Through the Arkansas Department of Health, the state offered a free, statewide, intensive, evidence-based tobacco dependence treatment program delivered in two modalities: over the telephone and in person. Extensive clinical, demographic, SES-related, and outcome data were collected on approximately12,000 smokers seeking treatment. Data from this treatment program provide unique opportunities to clinically and demographically describe and compare treatment outcomes as a function of treatment modality, independent of treatment content, and to identify factors that predict success for each modality in this primarily lower SES sample. Factors that predict success in quitting for lower SES groups may differ by modality, as well as from factors that generally predict success for higher SES groups. In the proposed study, we will analyze existing data from this tobacco dependence treatment program, pursuing the following specific aims: (1) Describe and compare the demographic and clinical characteristics of tobacco users who elect telephone versus in-person treatment, using descriptive statistics and significance testing; (2) compare treatment utilization and treatment exposure for telephone and in-person modalities, using descriptive statistics and significance testing; (3) compare treatment outcomes for telephone and in-person modalities, using logistic regression and generalized estimating equations modeling; and (4) compare treatment outcomes as a function of traditional demographic and clinical predictor variables, as well as other SES-related contextual factors such as support from work and health care providers, using logistic regression modeling. Congruent with the goals and recommendations of the NCI Tobacco Control Research Branch and the Clinical Practice Guideline, this study will (1) describe variations in treatment based on sociocultural factors including novel information (a) on a community-based sample of tobacco users who access treatment and (b) about treatment utilization and outcomes relative to SES-related variables; the study will also (2) generate new information about applying, promoting, and disseminating evidence-based interventions in clinical and public health practice and contribute to tobacco control policy development. This study is especially important and timely given that the current population of smokers in the U.S. comprises largely lower SES groups, that 25% of the U.S. population resides in rural areas, that all 50 states now provide some form of publicly funded tobacco cessation assistance through quit lines, and that there is a dearth of information about the impact of sociocultural and clinical factors in publicly funded programs relative to treatment utilization and outcomes. PUBLIC HEALTH RELEVANCE: PROJECT NARRATIVE Socioeconomic status (SES) clearly plays a significant role in tobacco use and the outcomes of tobacco dependence treatment, although we do not yet understand how the various factors involved, including education and income levels, exert their influence. In view of the largely lower SES of the current population of smokers in the U.S., the considerable size (25%) of the U.S. rural population, the provision by all 50 states of some form of publicly funded tobacco cessation assistance through quitlines, and the dearth of information about the impact of sociocultural and clinical factors in publicly funded treatment programs, the proposed study will examine the characteristics of participants in a statewide, six-session, evidence-based tobacco dependence treatment program delivered in two different treatment modalities: over the telephone and in person. The information to be gained from the analysis of this treatment program will help understand, address, and eventually eliminate disparities in tobacco use and in the outcomes of tobacco dependence treatment.