Low-income Smokers Research Articles

Identification and recruitment of low-income pregnant smokers: Who are we missing?

Extensive research has demonstrated the health consequences of smoking during pregnancy for both the mother and child. The majority of women, however, continue to smoke throughout the pregnancy and, of those who do quit, the majority return to smoking during the pregnancy or shortly after delivering the child. To best address this important public health problem, three critical goals must be accomplished: (1) development of effective interventions to help women quit smoking during pregnancy; (2) development of effective interventions to help women stay smoke-free during and after pregnancy; and (3) identification of effective methods of reaching women who smoke during pregnancy. Recruitment is the first window of opportunity to maximize our public health impact with pregnant women. Effective recruitment of women across all stages of change is needed, including both preaction stages and action stages. The current article examines the smoking habits of a large sample of low-income pregnant women. It compares those who enrolled in an intervention trial with those who did not enroll on a number of sociodemographic and individual characteristics, smoking patterns, and stage of change. The participants included 2280 pregnant women. Significant differences were found between enrollment groups on a number of variables, including stage of change [ χ 2(4)=54.74, P<.001], gestational age [ t(955)=11.93, P<.001], and multiple smoking pattern variables ( P<.001). In addition, a trend was found for ethnicity [ χ 2(5)=11.15, P<.05]. The findings of this study may help guide the development of enhanced recruitment strategies to expand our reach and thus our impact in this special population of smokers.

Depressive symptoms, stress, and weight concerns among African American and European American low-income female smokers.

Depressive symptoms, stress, and weight concerns among African American and European American low-income female smokers.

Pilot study of enhanced tobacco-cessation services coverage for low-income smokers.

This study explored the feasibility of covering nicotine replacement therapy (NRT) and paying for pharmacist-delivered smoking cessation counseling at the time of NRT pick-up for low-income, managed Medicaid and Basic Health Plan (a state insurance program) enrollees. A prospective pilot intervention was used at two community health centers (CHCs) and two community pharmacies. Participants were adult managed-Medicaid or Basic Health Plan enrollees who attended the pilot CHCs and smoked. An innovative insurance benefit that included coverage for NRT and $15 payment to the pharmacist to deliver cessation counseling with each prescription fill. Proportion of eligible patients who used the cessation benefit and patient and pharmacist satisfaction with the intervention. During the 9-month intervention, 32 patients at the pilot clinics were referred for NRT and pharmacist-delivered counseling. This number represented roughly 5% of eligible smokers. Of these, 26 received NRT with concomitant pharmacist-delivered cessation counseling at least once. Recipients reported a high level of satisfaction with this intervention. Pharmacists indicated they would continue providing counseling if reimbursement remained adequate and if counseling lasted no longer than 5-10 min. However, 12 (38%) who were referred were no longer insured by the sponsoring plan by the end of the 9-month pilot period. Pharmacist-delivered cessation counseling may be feasible and merits further study. More importantly, this pilot reveals two key obstacles in our low-income, culturally diverse setting: low participation and rapid turnover of insureds. Future interventions will need to address these barriers.

Randomized controlled trial of cognitive behavioural therapy for smokers living in a deprived area of London: Outcome at one-year follow-up

In order to reach the smoking prevalence targets set by the UK government, it is necessary to increase the adult quit rates, especially among smokers on low incomes. One way of increasing quit rates is to provide cost-effective smoking cessation therapy within the National Health Service (NHS). This paper compares the efficacy of smoking cessation advice in a health promotion campaign with that of an alternative intervention consisting of a cognitive behavioural therapy for smokers, the QUIT FOR LIFE Programme. Two hundred and sixty self- and GP-referred smokers took part in a randomized controlled trial with follow-up at 12 months. All lived in an economically deprived area of north London. At a 12-month follow-up, 23 of 116 participants (19.8%) receiving therapy were abstinent and ten (8.6%) had reduced cigarette consumption by at least 25% of the pre-treatment level. Six (5.8%) of 104 participants in the control group were abstinent and none had reduced consumption. Cognitive behavioural therapy can provide a cost-effective intervention for low-income smokers and should be available within the NHS in addition to nicotine replacement therapy.

Reasons for quitting smoking among low-income African American smokers.

Reasons for quitting smoking among low-income African American smokers.

“They're doing people a service”—qualitative study of smoking, smuggling, and social deprivation

Objectives: To examine the behaviour and attitudes related to smoking and contraband tobacco products among smokers in two socially deprived areas.Design: Cross sectional study with qualitative semistructured interviews, augmented by...

A nicotine fix on the NHS

British smokers keen to kick the habit have received a welcome boost with the government's announcement that all nicotine replacement therapies (NRTs) will soon be available on the National Health Service. The timely move – which came on National No Smoking Day – is expected to benefit low-income smokers who do not pay for prescriptions. And with certain NRTs, including patches, lozenges and gums, being made available for general sale, the future looks bright for those hoping to beat their addiction. RC

Reasons for quitting smoking among low-income African American smokers.

The psychometric characteristics of the Reasons For Quitting scale (RFQ) were assessed among a sample of African American smokers with low income (N=487). The intrinsic and extrinsic scales and their respective subscales were replicated. As hypothesized, higher levels of motivation were associated significantly, in patterns that supported the measure's construct validity, with advanced stage of readiness to quit smoking, greater perceived vulnerability to health effects of smoking, and greater social support for cessation. On the basis of the present study, the RFQ might best predict short-term cessation among older and female smokers. Refinement of the RFQ is needed to assess intrinsic motivators other than health concerns and to identify salient motivators for young and male smokers.

Interventions to prevent weight gain: a systematic review of psychological models and behaviour change methods.

To identify and review published interventions aimed at the prevention of weight gain. A systematic review of published interventions aimed at the prevention of weight gain. Search strategies-we searched eight databases, manually checked reference lists and contacted authors. Inclusion and exclusion criteria-studies of any design, in which participants were selected regardless of weight or age, were included. Interventions targeting a specific subgroup, multifactorial interventions, interventions aimed at weight loss, and those with an ambiguous aim were excluded. Data extraction-data were extracted on behaviours targeted for change, psychological model, behaviour change methods and modes of delivery, methodological quality, characteristics of participants, and outcomes related to body weight and self-reported diet and physical activity. Classification and validation-a taxonomy of behaviour change programmes was developed and used for classification of underlying model, behaviour change methods, and modes of delivery. The data extraction and subsequent classification were independently validated. Eleven publications were included, describing five distinct interventions in schools and four in the wider community. Where diet and physical activity were described, positive effects were usually obtained, but all were measured by self-report. Effects on weight were mixed but follow-up was generally short. Smaller effects on weight gain were found among low-income participants, students and smokers. Many participants in the community-based studies were overweight or obese. Study dropout was higher among thinner and lower-income subjects. Interventions to prevent weight gain exhibited various degrees of effectiveness. Definite statements about the elements of the interventions that were associated with increased effect size cannot be made as only one of the five studies that involved an RCT design reported a significant effect on weight. This intervention involved a correspondence programme and a mix of behaviour change methods including goal setting, self-monitoring and contingencies. Future interventions might be more effective if they were explicitly based on methods of behaviour change that have been shown to work in other contexts. Effective interventions would be more easily replicated if they were explicitly described. Effectiveness might be more precisely demonstrated if more objective measures of physical activity and diet were used, and if the follow-up was over a longer period. International Journal of Obesity (2000) 24, 131-143

Acceptability of computer assessments among ethnically diverse, low-income smokers.

To examine the acceptability of computer-based assessments among an ethnically diverse, low-income population of primary care patients. Although computers have been used to provide assessments and interventions in health care settings, members of ethnic minority and low-income households have less access to computers than other groups, and therefore the acceptability of computers as a health care assessment and delivery tool needs to be examined. We examined the acceptability of computers for providing assessments of smoking history, nicotine dependence, and other related variables among an ethnically diverse, low-income primary care population. No intervention was used in this study. Three inner-city primary care clinics located in hospitals were used as sites for this study. These hospitals were located in areas of the city where low-income and ethnic minority households are overrepresented relative to the total population. Adult male and female smokers (n = 522) were recruited while awaiting appointments in each primary care clinic. A questionnaire assessing smoking rate, patterns, history, motivation to quit smoking, and other smoking-related variables was administered using either a paper-and-pencil format or a laptop computer. Frequency counts, analysis of variance, and chi 2 tests were used where appropriate. Most subjects (78.5%) used the computer to complete the baseline survey. Almost all subjects (92%) rated the computer "very easy" or "easy" to use. Subjects who were Spanish-speaking, were born outside the United States, or were Hispanic tended to rate the program as slightly less easy to use than other subjects. Computer-based assessments appear highly acceptable to individuals in low-income populations.

Reactions of adult and teenaged smokers to the Massachusetts tobacco tax.

This study assessed smokers' reactions to a 25 cents cigarette tax imposed in Massachusetts. A statewide telephone survey of 1783 adult smokers and 216 teenaged smokers was conducted. Among adult smokers, 3.5% reported that they had stopped smoking, owing in part to the price increase; 35% had considered quitting and 19% had attempted to cut the cost of smoking by switching to cheaper brands or cutting down. Among teenagers, 21% had considered quitting and 26% had cut costs. Low-income smokers were more responsive to the price increase than more affluent smokers. A modest and temporary price increase promoted quitting among adult smokers and reduced cigarette consumption among low-income teenagers.

Use of the nicotine skin patch by smokers in 20 communities in the United States, 1992-1993.

OBJECTIVE: To measure the characteristics of smokers associated with the use of the nicotine skin patch in the general population and to evaluate whether use of the patch is associated...

Use of Transdermal Nicotine in a State-Level Prescription Plan for the Elderly

To assess transdermal nicotine use patterns and outcomes in a population of low-income older smokers. A 6-month telephone follow-up survey of smokers filling prescriptions for transdermal nicotine in the first 3 months of 1992. Pennsylvania's Pharmaceutical Assistance Plan for the Elderly, the nation's largest state-level prescription plan for the elderly. A total of 1070 noninstitutionalized male and female smokers aged 65 through 74 years. Self-reported physician/pharmacist advice and adjunctive treatments, concomitant smoking, and 6-month smoking abstinence. Respondents were predominantly long-term heavy smokers. They used nicotine patches for an average of 5 weeks, with few reporting use beyond 3 months or recalling bothersome side effects. Most of those with previous quit attempts rated quitting with the patch "easier." The 29% self-reported 6-month quit rate observed is encouraging. However, compliance with patch use guidelines was far from ideal in this high-risk population: only 54% of respondents received any initial advice or materials from their physicians or pharmacists, fewer than 2% took part in a formal clinic or one-to-one treatment program, and almost half (47%) smoked while using the patch, including 20% who smoked every day. Concomitant smoking was strongly associated with failure to achieve abstinence (P < .001). More frequent contact with physicians and/or pharmacists was associated with less concomitant smoking (P < .001) and higher quit rates (P = .005). This survey offers an important first look at problems and prospects for nicotine patch therapy in older adults, with implications for other groups as well. Prospective studies are needed to clarify optimal treatment regimens and adjuncts.