Recent evidence indicates that the prevalence of current cigarette smoking among adults in the US has dropped below 20%. While this drop is encouraging, smoking still represents the leading cause of preventable morbidity and mortality in the US. Moreover, smoking prevalence is significantly higher among certain population groups, such as those with low levels of education and those living at, or below the poverty level. Therefore, efforts to target these underserved populations with efficacious smoking cessation treatments represents a vital public health effort. The overarching goal of this group-randomized trial is to design and evaluate a novel smoking cessation program targeted to uninsured and underinsured individuals. Key elements of the proposed study will be the use of an established network of community sites (e.g., community centers and churches) and a mobile unit, enabling us to reach individuals confronted with significant barriers to utilizing more traditional smoking cessation treatment approaches.
Specific aims of the study will be to: 1) Compare the efficacy of three smoking cessation interventions targeting community based low income uninsured and underinsured individuals in a group-randomized trial. The interventions will include a Standard Care (SC) approach, consisting of brief advice to quit smoking, nicotine replacement therapy (NRT), and self-help written materials;an Enhanced Care (EC) approach, consisting of the standard care components plus a single health feedback and motivational interviewing counseling session and a cell phone-delivered text/graphical messaging component;and an Intensive Care (IC) approach, consisting of all SC and EC components plus a series of 11 cell phone-delivered proactive counseling sessions and a cell phone-delivered text/graphical messaging component;2) Evaluate the role of quit motivation, nicotine withdrawal, risk perception, self- efficacy, social support, and negative affect as potential mediators of smoking abstinence;and 3) Compare the cost-effectiveness of the three treatment conditions. We believe that of the three conditions, the IC will most successfully address the needs of low-income smokers for several reasons. First, the IC program will be personalized, individualized, and equipped with an intensive, extended counseling and support module provided over the cell phone. Second, the program will combine three intervention components featuring high potential for maintaining support and motivation to quit and prevent relapse. Third, the IC intervention makes use of cell phone technology - an approach that has demonstrated feasibility and efficacy among low-income smokers in previous research conducted by the investigative team. The proposed study offers a number of features (proximity of services to the place of residence, provision of cell phones, etc.) that are likely to reduce treatment barriers while enhancing participant recruitment and retention.
The proposed study will use an existing network of community sites and a mobile unit to deliver smoking cessation treatment to a multiethnic population of uninsured and underinsured adults living in the greater Houston, Texas metropolitan area. The treatments will include components such as brief advice to quit, nicotine patch, written materials, motivational interviewing/health feedback counseling, text/pix messaging, and proactive cell phone counseling.