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

美国吸烟遵循明显的社会经济梯度：低收入美国人 与那些受教育程度和收入较高的人相比，吸烟更多，戒烟更少。循证的 像戒烟这样的干预措施是为了有效戒烟。 向所有吸烟者提供以人口为基础的服务，而不考虑经济状况。 然而，这些干预措施并不是专门为经济弱势群体设计的 人口，因此没有解决低收入者面临的许多独特挑战 有收入的吸烟者。随着美国吸烟人口结构的持续变化，美国的吸烟人口也在不断变化 必须采取控制吸烟的策略，包括帮助吸烟者戒烟。 这项拟议的研究将测试帮助低收入吸烟者的两项创新的效果 退出：一条专门的Quitline和基本需求导航。在低收入人群中， 食品、住房、人身安全和生活必需品等基本需求被取代 健康需求。我们已经证明，在低收入吸烟者中，那些有 多个未得到满足的基本需求明显不太可能联系戒烟转介，他们 收到了，甚至不太可能记得得到了推荐。但当基本需求 问题解决了，拨打放弃电话的几率就增加了。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，它们的效力将有限 经济上的弱势群体。因此，像QuiLine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，它们就更有益。 使用2x2随机析因设计，我们将比较标准和 有无戒烟基本需求导航器的专业戒烟热线 在2000名低收入吸烟者中。主要的研究结果是自我报告的7天 在6个月的随访中，对戒断点的患病率进行生化验证。这 全州范围的现场试验将吸引密苏里州联合之路2-1-1的吸烟者，并将他们推荐到 密苏里州烟草Quitline，由Alere Wellbeing，Inc.提供，两者都是主要成员 研究小组的成员。将这项研究嵌入这些实践机构将加速 如果我们的研究结果支持它，那么应用程序的路径。

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.