Connecting low-income smokers to tobacco treatment services. (January 2016)

• Record Type: Journal Article
• Authors: Slater, Jonathan S.; Nelson, Christina L.; Parks, Michael J.; Ebbert, Jon O.
• Is Part Of: Addictive behaviors. Volume 52(2016)
• Page Start: 108
• Page End: 114
• Publication Date: 2016-01
• Subjects: Population-based programs -- Smoking cessation -- Underserved populations -- Telehealth -- Financial incentive; Substance abuse -- Periodicals; Alcoholism -- Periodicals; Drug addiction -- Periodicals; Nicotine addiction -- Periodicals; Smoking -- Periodicals; Gambling -- Psychological aspects -- Periodicals; Electronic journals; 362.29
• DOI: 10.1016/j.addbeh.2015.10.013
• Languages: English
• ISSNs: 0306-4603

Abstract

Abstract: The Affordable Care Act calls for using population-level incentive-based interventions, and cigarette smoking is one of the most significant health behaviors driving costs and adverse health in low-income populations. Telehealth offers an opportunity to facilitate delivery of evidence-based smoking cessation services as well as incentive-based interventions to low-income populations. However, research is needed on effective strategies for linking smokers to services, how to couple financial incentives with telehealth, and on how to scale this to population-level practice. The current paper evaluates primary implementation and follow-up results of two strategies for connecting low-income, predominantly female smokers to a telephone tobacco quitline (QL). The population-based program consisted of participant-initiated phone contact and two recruitment strategies: (1) direct mail (DM) and (2) opportunistic telephone referrals with connection (ORC). Both strategies offered financial incentives for being connected to the QL, and all QL connections were made by trained patient navigators through a central call center. QL connections occurred for 97% of DM callers (N = 870) and 33% of ORC callers (N = 4550). Self-reported continuous smoking abstinence (i.e., 30 smoke-free days at seven-month follow-up) was 20% for the DM group and 16% for ORC. These differences between intervention groups remained in ordered logistic regressions adjusting for smoking history and demographic characteristics. Each recruitment strategy had distinct advantages; both successfully connected low-income smokers to cessation services and encouraged quit attempts and continuous smoking abstinence. Future research and population-based programs can utilize financial incentives and both recruitment strategies, building on their relative strengths. Highlights: We designed two strategies for connecting low-income smokers to quitline services. Strategies were direct mail and opportunistic referral; both employed incentives. Each strategy reached individuals at differential levels of readiness to quit. Smoking abstinence rates at follow-up indicated both strategies had high impact. Both strategies had strengths, and both can be used in population-based practice.