Socioeconomic disparities in telephone-based treatment of tobacco dependence
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Merilyn Varghese1, Christine Sheffer, Maxine Stitzer
1Merilyn Varghese and Christine Sheffer are with the Department of Community Health and Social Medicine, Sophie Davis School of Biomedical Education, City College of New York, New York, NY. Maxine Stitzer is with Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD. Reid Landes is with the Department of Biostatistics, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock. S. Laney Brackman and Tiffany Munn are with the Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences.
Objectives:
We examined socioeconomic disparities in tobacco dependence treatment outcomes from a free, proactive telephone counseling quitline.
Methods:
We delivered cognitive-behavioral treatment and nicotine patches to 6626 smokers and examined socioeconomic differences in demographic, clinical, environmental, and treatment use factors. We used logistic regressions and generalized estimating equations (GEE) to model abstinence and account for socioeconomic differences in the models.
Results:
The odds of achieving long-term abstinence differed by socioeconomic status (SES). In the GEE model, the odds of abstinence for the highest SES participants were 1.75 times those of the lowest SES participants. Logistic regression models revealed no treatment outcome disparity at the end of treatment, but significant disparities 3 and 6 months after treatment.
Conclusions:
Although quitlines often increase access to treatment for some lower SES smokers, significant socioeconomic disparities in treatment outcomes raise questions about whether current approaches are contributing to tobacco-related socioeconomic health disparities. Strategies to improve treatment outcomes for lower SES smokers might include novel methods to address multiple factors associated with socioeconomic disparities.
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