Proactive Tobacco Cessation Outreach to Smokers of Low Socioeconomic Status: A Randomized Clinical Trial | Journal Scan

Study Questions:

Is a proactive tobacco cessation strategy which targets socio-contextual mediators of tobacco use effective for low socioeconomic status (SES) smokers?


This was a prospective randomized clinical trial, which enrolled low-SES adult smokers. Participants who described their race and/or ethnicity as black, Hispanic, or white and received primary care at 1 of 13 practices in the greater Boston area (intervention group, n = 399; control group, n = 308) were eligible to participate. Interactive voice response techniques were used to contact potential participants. Consenting patients were randomized to either receive usual care from their own health care team or enter an intervention program that included: 1) telephone-based motivational counseling, 2) free nicotine replacement therapy for 6 weeks, 3) access to community-based referrals to address socio-contextual mediators of tobacco use, and 4) integration of all these components into their normal health care through the electronic health record (HER) system. The primary outcome of interest was self-reported past-7-day tobacco abstinence 9 months after randomization (“quitting”), assessed by automated caller or blinded study staff.


A total of 8,544 potential participants were identified through HER data, of which 8,089 were verified as eligible; 5,008 (61.9%) were not able to be contacted through the interactive-voice response system. A total of 707 (8.3% of those eligible) agreed to participate; 66% of participants completed the outcome assessment call 9 months after enrollment. The median age of participants was 50 years; 68% were women, 20% self-reported Hispanic ethnicity, and 28% black; 36% reported their highest level of educational attainment to be high school or less, and 35% had Medicaid. Compared with the control group, those in the intervention group were more likely to report smoking cessation. The quit rate in the intervention group was 17.8% vs. 8.1% in the usual care group (odds ratio, 2.5; 95% confidence interval, 1.5-4.0; number needed to treat, 10). Participants who participated in the telephone counseling were more likely to quit than those who did not (21.2% vs. 10.4%; p < 0.001). There was no difference in quitting by use of nicotine replacement therapy.


The investigators concluded that a proactive, interactive-voice response facilitated outreach enables engagement with low-SES smokers. Providing counseling, nicotine replacement therapy, and access to community-based resources to address socio-contextual mediators among smokers were effective.


This study suggests proactive programs which target low-SES smokers can be effective. Confirmation of these findings with verified long-term abstinence of smoking cessation is needed prior to wide spread adoption of such programs.

Keywords: African Americans, Boston, Counseling, Electronic Health Records, Hispanic Americans, Medicaid, Nicotine, Patient Care Team, Primary Health Care, Smoking Cessation, Social Class, Tobacco Use Disorder, Tobacco Use Cessation

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