Treatment modality and socioeconomic status in treating tobacco dependence

描述（由申请人提供）： 较低的社会经济地位（SES）和农村群体在吸烟者中所占比例过高，并不成比例地患有烟草相关疾病。阿肯色州的社会经济地位较低和农村居民比例很高，也是全国吸烟率最高的地区之一。通过阿肯色州卫生部，该州提供了一个免费的、全州范围内的、强化的、以证据为基础的烟草依赖治疗计划，该计划以两种方式提供：电话和面对面。收集了大约12,000名寻求治疗的吸烟者的广泛的临床、人口统计学、SES相关和结果数据。来自该治疗计划的数据提供了独特的机会，可以在临床和人口统计学上描述和比较治疗结果，作为治疗方式的函数，独立于治疗内容，并确定在这种主要较低SES样本中预测每种方式成功的因素。预测较低SES组戒烟成功的因素可能因方式而异，以及通常预测较高SES组成功的因素。在本研究中，我们将分析现有的烟草依赖治疗计划的数据，具体目标如下：（1）使用描述性统计和显著性检验，描述和比较选择电话与面对面治疗的烟草使用者的人口统计学和临床特征;（2）使用描述性统计和显著性检验，比较电话和面对面方式的治疗利用和治疗暴露;（3）使用逻辑回归和广义估计方程模型比较电话和面对面方式的治疗结果;以及（4）比较作为传统人口统计学和临床预测变量的函数的治疗结果，以及其他SES相关的背景因素，例如来自工作和健康护理提供者的支持，使用逻辑回归模型。与NCI烟草控制研究分支和临床实践指南的目标和建议一致，本研究将（1）描述基于社会文化因素的治疗变化，包括新信息（a）关于获得治疗的烟草使用者的社区样本和（B）关于治疗利用和与SES相关变量相关的结局;该研究还将（2）产生关于在临床和公共卫生实践中应用、促进和传播循证干预措施的新信息，并有助于烟草控制政策的制定。这项研究特别重要和及时，因为美国目前的吸烟人口主要包括社会经济地位较低的群体，25%的美国人口居住在农村地区，所有50个州现在都通过戒烟热线提供某种形式的公共资助戒烟援助，并且缺乏关于社会文化和临床因素在公共资助项目中对治疗利用和结果的影响的信息。 公共卫生相关性： 社会经济地位（SES）显然在烟草使用和烟草依赖治疗的结果中起着重要的作用，尽管我们还不了解所涉及的各种因素，包括教育和收入水平，如何发挥其影响。鉴于美国目前吸烟者的社会经济地位很低，美国农村人口的相当大的规模（25%），所有50个州通过戒烟热线提供某种形式的公共资助戒烟援助，以及缺乏关于公共资助治疗计划中社会文化和临床因素影响的信息，拟议的研究将在全州范围内，六次会议，以证据为基础的烟草依赖治疗方案以两种不同的治疗方式提供：通过电话和亲自。从分析该治疗方案中获得的信息将有助于理解，解决并最终消除烟草使用和烟草依赖治疗结果的差异。

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.