Helping the poor quit smoking: specialized quitlines and meeting basic needs

吸烟在美国遵循明显的社会经济梯度：低收入美国人 与那些受教育程度高、收入高的人相比，他们吸烟更多、戒烟更少。循证 像戒烟热线这样的干预措施旨在使有效的戒烟 向所有吸烟者提供基于人口的服务，不论其经济状况如何。 然而，这些干预措施并不是专门为经济脆弱者设计的 人口，因此不能解决低收入者面临的许多独特挑战， 收入吸烟者随着美国吸烟人口的不断变化， 必须采取控制吸烟的策略，包括帮助吸烟者戒烟。 这项拟议中的研究将测试两项创新的效果，以帮助低收入吸烟者 quit：一个专门的Quitline和基本需求导航。在低收入人群中， 食物、住房、人身安全和生活必需品等基本需求取代了 健康需求。我们已经证明，在低收入吸烟者中， 多个未满足的基本需求明显不太可能联系戒烟热线， 收到，和不太可能记得甚至得到转介。但当基本需求 问题解决了，要求退出的可能性就增加了。满足基本需求 因此，应该增加低收入吸烟者参与戒烟计划。 然而，如果这些方案不与以下方面相关， 经济弱势群体。因此，像退出线这样经过验证的方法应该是 当它们适应穷人的背景和生活环境时，就更有益。 使用2x2随机析因设计，我们将比较标准和 专门的戒烟热线，有和没有关于戒烟的基本需求导航 2000名低收入吸烟者主要研究结局是自我报告的7天 6个月随访时的点流行率禁欲，生化验证。这 全州范围的现场试验将吸引来自联合路2-1-1密苏里州的吸烟者，并将他们转介到 由Alere Wellbeing，Inc.提供的密苏里州烟草戒烟热线。两人都是关键成员 的研究团队。在这些实践机构中嵌入研究将加速 我们的研究结果应该支持它。

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.