Smoking remains the leading preventable cause of death in the United States (US), and is a well established cause of lung cancer. Although smoking rates have declined over the past several decades, there remain substantial disparities in smoking . Importantly, low socioeconomic status (SES) and minority smokers have a more difficult time quitting for a variety of reasons including more limited access to treatment, misinformation about the risks and benefits of treatment options, more environmental exposure, lack of social support, and other life stressors. While the majority of smokers visit a primary care physicain each year, busy clinicians frequently do not address tobacco use during a visit. Minority and low SES smokers are more likely than whites to report that they did not receive counseling or treatment during a visit. For these reasons it is important to offer systematic opportunities for tobacco treatment beyond the provider's office. Interactive Voice Response (IVR) is a phone technology that allows a computer to detect voice responses during a normal phone call. This technology offers a low-cost, efficient way to proactively reach out to large populations, independent of a visit. The objectives of this project are to develop and evaluate a multi-level approach to tobacco treatment for low-SES and minority patients. The components include: (1) IVR-facilitated systematic outreach, linkage to a tobacco treatment specialist, and free nicotine replacement therapy directed at the patient, and integration of this program with both (2) an individual's primary care physician through an electronic health record (EHR) with integrated tobacco-related decision support, and (3) referral to tailored community resources to address the socio-contextual barriers to tobacco cessation. We therefore propose the following Specific Aims:
Specific Aim 1 : To develop an EHR-linked, IVR-mediated tailored tobacco treatment program for low-SES and minority smokers.
Specific Aim 2 : To measure the effectiveness of this tailored treatment program by conducting a randomized controlled trial of low SES and minority smokers in the Partners Primary Care Practice Based Research Network. The primary outcome of this trial will be the 7-day abstinence rate at 6 months.
Specific Aim 3 : To evaluate facilitators and barriers to the reach, adoption, and implementation of this tailored tobacco treatment program.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Specialized Center (P50)
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Special Emphasis Panel (ZCA1-SRLB-3)
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Harvard University
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