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Kim-Mozeleski JE, Castele MC, Nambiar P, Chagin KM, Pike Moore S, Hardy P, Cook K, Sehgal AR. A Randomized Trial to Address Food Insecurity and Promote Smoking Cessation Among Low-Income Adults. J Prim Care Community Health 2024; 15:21501319241245275. [PMID: 38584453 PMCID: PMC11003330 DOI: 10.1177/21501319241245275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/09/2024] Open
Abstract
Many low-income adults who smoke also have unmet social needs, such as food insecurity, which can serve as a barrier to smoking cessation. We developed a novel intervention to jointly address smoking cessation and food insecurity and assessed its feasibility, acceptability, and preliminary outcomes. We enrolled participants who screened for food insecurity, reported smoking daily, and were ready to quit. All participants received 3 months of resources navigation from a community health worker through monthly telephone calls for referrals and check-ins for smoking cessation and food access resources. Participants randomized to the intervention group received an economic intervention equivalent to the cost of 1 week of groceries/month for 3 months. We randomized 55 participants who were smoking on average 13 cigarettes/day. The trial was feasible and acceptable based on 3-month retention rates (80%) and end-of-study qualitative feedback (91% would recommend the study to others). At 3 months, participants in the intervention versus control group reported a longer length of abstinence from smoking and had a higher proportion of serious quit attempts. Results from this pilot study suggest the importance of attending to social needs, particularly food insecurity, as a strategy to promote smoking cessation among low-income adults who smoke.
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Affiliation(s)
| | | | | | - Kevin M. Chagin
- The Institute for H.O.P.E.™, The MetroHealth System, Cleveland, OH, USA
| | | | - Patricia Hardy
- The Institute for H.O.P.E.™, The MetroHealth System, Cleveland, OH, USA
| | - Karen Cook
- The Institute for H.O.P.E.™, The MetroHealth System, Cleveland, OH, USA
| | - Ashwini R. Sehgal
- The Institute for H.O.P.E.™, The MetroHealth System, Cleveland, OH, USA
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Winslow VA, Jagai JS, Makelarski JA, Wroblewski KE, Lindau ST, Vu M. Social Risk and Smoking Among Women Smokers Early in the COVID-19 Pandemic: The Role of Mental Health. J Womens Health (Larchmt) 2023; 32:960-969. [PMID: 37379463 PMCID: PMC10510694 DOI: 10.1089/jwh.2023.0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023] Open
Abstract
Background: We examined patterns of smoking in relation to health-related socioeconomic vulnerability (HRSV) among U.S. women early in the pandemic and whether mental health symptoms mediated these relationships. Materials and Methods: Data were obtained from the April 2020 National U.S. Women's Health COVID-19 Study (N = 3200). Among current smokers, adjusted odds of increased smoking since the start of the pandemic (vs. same or less) by incident and worsening HRSVs were modeled. Structural equation modeling was used to assess anxiety, depression, and traumatic stress symptoms as mediators of the relationship between six HRSVs (food insecurity; housing, utilities, and transportation difficulties; interpersonal violence; financial strain) and increased smoking early in the pandemic. Results: Nearly half (48%) of current smokers reported increased smoking since the pandemic started. Odds of increased smoking were higher among women with incident financial strain (aOR = 2.0, 95% CI 1.2-3.3), incident food insecurity (aOR = 2.9, 95% CI 1.7-5.1), any worsening HRSV (aOR = 2.2, 95% CI 1.5-3.0), and worsening food insecurity (aOR = 1.9, 95% CI 1.3-3.0). Anxiety symptoms were a significant, partial mediator of the relationship between increased smoking and any worsening HRSVs (proportion mediated = 0.17, p = 0.001) and worsening food insecurity (0.19, p = 0.023), specifically. Depression symptoms were a significant, partial mediator of the relationship between increased smoking and any worsening HRSVs (0.15, p = 0.004) and incident financial strain (0.19, p = 0.034). Traumatic stress was not a significant mediator of any tested relationship. Conclusions: Anxiety and depression symptoms partially explain the relationship between rising socioeconomic vulnerability and increased smoking among women early in the pandemic. Addressing HRSVs and mental health may help reduce increased smoking during a public health crisis.
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Affiliation(s)
- Victoria A. Winslow
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Jyotsna S. Jagai
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Jennifer A. Makelarski
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Kristen E. Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology and Medicine-Geriatrics and Palliative Medicine, The University of Chicago and The University of Chicago Comprehensive Cancer Center, Chicago, Illinois, USA
| | - Milkie Vu
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
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Kreuter MW, Garg R, Fu Q, Caburnay C, Thompson T, Roberts C, Sandheinrich D, Javed I, Wolff JM, Butler T, Grimes LM, Carpenter KM, Pokojski R, Engelbrecht K, Howard V, McQueen A. Helping low-income smokers quit: findings from a randomized controlled trial comparing specialized quitline services with and without social needs navigation. LANCET REGIONAL HEALTH. AMERICAS 2023; 23:100529. [PMID: 37408953 PMCID: PMC10319314 DOI: 10.1016/j.lana.2023.100529] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 07/07/2023]
Abstract
Background Quitting smoking is especially challenging for low-income smokers due to high stress, high smoking prevalence around them, and limited support for quitting. This study aimed to determine whether any of three interventions designed specifically for low-income smokers would be more effective than standard tobacco quitline services: a specialized quitline, the specialized quitline with social needs navigation, or the standard quitline with social needs navigation. Methods Using a randomized 2 × 2 factorial design, low-income daily cigarette smokers (n = 1944) in Missouri, USA who called a helpline seeking assistance with food, rent or other social needs were assigned to receive Standard Quitline alone (n = 485), Standard Quitline + Social Needs Navigation (n = 484), Specialized Quitline alone (n = 485), or Specialized Quitline + Social Needs Navigation (n = 490). The target sample size was 2000, 500 per group. The main outcome was 7-day self-reported point prevalence abstinence at 6-month follow-up. Multiple imputation was used to impute outcomes for those missing data at 6-month follow-up. Binary logistic regression analyses were used to assess differences between study groups. Findings Participants were recruited from June 2017 to November 2020; most were African American (1111 [58%]) or White (666 [35%]), female (1396 [72%]), and reported <$10,000 (957 [51%]) or <$20,000 (1529 [82%]) annual pre-tax household income. At 6-month follow-up (58% retention), 101 participants in the Standard Quitline group reported 7-day point prevalence abstinence (20.8% of those assigned at baseline, 38.1% after imputation). Quit rates in the Specialized Quitline (90 quitters, 18.6%, 38.1%) and Specialized Quitline + Social Needs Navigation (103 quitters, 21.0%, 39.8%) were not different from the Standard Quitline. Quit rates for Standard Quitline + Social Needs Navigation (74 quitters, 15.3%, 30.1%) were significantly lower than Standard Quitline (OR = 0.70, 95% CI = 0.50-0.98). Interpretation A specialized version of a state tobacco quitline was no more effective than standard quitline services in helping low-income smokers quit. Adding social needs navigation to a standard quitline decreased its effectiveness. Trial registration ClinicalTrials.gov Identifier: NCT03194958. Funding National Cancer Institute: R01CA201429.
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Affiliation(s)
- Matthew W. Kreuter
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Rachel Garg
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Qiang Fu
- Department of Community Health, Tufts University, Medford, MA, USA
| | - Charlene Caburnay
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Tess Thompson
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Christina Roberts
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Dominique Sandheinrich
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Irum Javed
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Jennifer M. Wolff
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Taylor Butler
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Lauren M. Grimes
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | | | - Robin Pokojski
- Community Partnerships, United Way of Greater St. Louis, St. Louis, MO, USA
| | | | - Valerie Howard
- Tobacco Prevention and Control Program, Missouri Department of Health and Senior Services, Jefferson City, MO, USA
| | - Amy McQueen
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
- Division of General Medical Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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Peiffer G, Perriot J, Underner M, Rouquet RM. [Smoking cessation treatment for smokers with COPD: The importance of therapeutic education]. Rev Mal Respir 2023:S0761-8425(23)00168-7. [PMID: 37208289 DOI: 10.1016/j.rmr.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/24/2023] [Indexed: 05/21/2023]
Abstract
Smoking is a major risk factor for chronic obstructive pulmonary disease (COPD). The diagnosis of tobacco addiction and management of tobacco dependence are part and parcel of COPD treatment, especially in respiratory rehabilitation. Management encompasses psychological support, validated treatments and therapeutic education. The objective of this review is to briefly recall the guiding principles of therapeutic patient education (TPE) as it applies to smokers wishing to quit and, more specifically, to present the tools conducive to shared educational assessment and treatment according to the Prochaska's stages of change model. We are also proposing an action plan and a questionnaire through which TPE sessions can be assessed. Finally, culturally adapted interventions and new communication technologies are taken into consideration insofar as they constructively contribute to TPE.
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Affiliation(s)
- G Peiffer
- Service de pneumologie, CHR Metz-Thionville, 1, allée du Château, 57085 Metz, France.
| | - J Perriot
- Dispensaire Emile Roux, CLAT 63, Centre de Tabacologie, 63100 Clermont-Ferrand, France
| | - M Underner
- Unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 86021 Poitiers, France
| | - R-M Rouquet
- Pneumologue tabacologue, CHU de Toulouse, 24, chemin de Pouvourville, 31059 Toulouse cedex 9, France
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McQueen A, Wartts JG, Garg R, Carpenter KM, Kreuter MW. Leveling the Playing Field: Mailing Pharmacotherapy to Medicaid Members Who Smoke. Am J Prev Med 2023; 64:227-234. [PMID: 36335079 PMCID: PMC10084723 DOI: 10.1016/j.amepre.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/31/2022] [Accepted: 09/12/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Smoking rates differ by insurance type; rates are often double for Medicaid and uninsured compared with that for Medicare or privately insured. State-funded tobacco quitlines' provision of free nicotine replacement therapy varies. In some states, Medicaid beneficiaries must obtain nicotine replacement therapy from a physician, whereas others get nicotine replacement therapy mailed to them. METHODS This secondary analysis examined the differences in the source and use of cessation treatment by insurance type and their impacts on cessation. The parent trial excluded people who were pregnant, had private insurance, or were not ready to quit. From June 1, 2017 to November 15, 2020, a total of 1,944 low-income people who smoke daily completed a baseline survey and were enrolled in a quitline program; 1,380 (71%) completed a 3-month follow-up. Analyses were completed in August 2022. Participants were classified as Medicaid/dual (55%), Medicare/Veterans Affairs (14%), or uninsured (31%). Nine months into the trial, owing to a system error, the quitline provided nicotine replacement therapy to all study participants regardless of insurance type. RESULTS Before error versus after error, Medicaid participants reported lower nicotine replacement therapy receipt (3.2% vs 50.8%) and use (32.4% vs 52.6%). The odds of quitting (7-day point prevalence) by 3 months increased for people who smoke who completed more quitline calls and used any (36% quit) versus used no (20% quit) pharmacotherapy, but quitting did not differ by insurance classifications (27%-29%). Getting and using nicotine replacement therapy from the quitline produced the highest quit rates (38%). CONCLUSIONS Results illustrate the benefit of receiving nicotine replacement therapy from the quitline on cessation. Mailing nicotine replacement therapy to all people who smoke should be standard practice to reduce smoking disparities.
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Affiliation(s)
- Amy McQueen
- John T. Milliken Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri; Health Communication Research Laboratory, Washington University Brown School, St. Louis, Missouri.
| | - Jordyn G Wartts
- Health Communication Research Laboratory, Washington University Brown School, St. Louis, Missouri
| | - Rachel Garg
- Health Communication Research Laboratory, Washington University Brown School, St. Louis, Missouri
| | | | - Matthew W Kreuter
- Health Communication Research Laboratory, Washington University Brown School, St. Louis, Missouri
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Thompson T, Evbuoma-Fike EI, Garg R, McQueen A, Caburnay C, Kreuter MW. Examining Psychosocial Correlates of a Home Smoking Ban Among Low-income Smokers: Analysis of Social Support, Unmet Social Needs, Perceived Stress, and Depressive Symptoms. J Community Health 2022; 47:959-965. [PMID: 35932354 PMCID: PMC9669155 DOI: 10.1007/s10900-022-01094-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 12/26/2022]
Abstract
Home smoking bans reduce exposure to second-hand smoke. Understanding how psychosocial factors are related to having a home smoking ban may lead to better interventions for populations less likely to have home smoking bans, including low-income smokers. In this study, we used baseline data from 1,944 participants in a randomized trial of low-income smokers in Missouri to explore psychosocial correlates of a total home smoking ban. Using logistic regression, we examined associations between psychosocial variables (social support, unmet social needs [e.g., food, housing], perceived stress, and depressive symptoms) and a total home smoking ban. 72% of participants were female, and 58% were Black/African American; 26% reported a home smoking ban. In unadjusted and adjusted models, greater social support was associated with greater likelihood of a home smoking ban. Stress was negatively associated with a ban in adjusted models only. The fact that most participants did not have a home smoking ban highlights the need for further intervention in this population. Results suggest links between social support and having a home smoking ban, although effect sizes were small. Smoke-free home interventions that increase social connectedness or leverage existing support may be especially effective. Tobacco control planners may also consider partnering with agencies addressing social isolation.
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Affiliation(s)
- Tess Thompson
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, 1 Brookings Dr, Campus Box 1196, 63130, St. Louis, MO, United States.
| | - Ebuwa I Evbuoma-Fike
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, 1 Brookings Dr, Campus Box 1196, 63130, St. Louis, MO, United States
| | - Rachel Garg
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, 1 Brookings Dr, Campus Box 1196, 63130, St. Louis, MO, United States
| | - Amy McQueen
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, 1 Brookings Dr, Campus Box 1196, 63130, St. Louis, MO, United States
- Division of General Medical Sciences, School of Medicine, Washington University in St. Louis, 4523 Clayton Avenue, Campus Box 8005, 63110, St. Louis, Missouri, United States
| | - Charlene Caburnay
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, 1 Brookings Dr, Campus Box 1196, 63130, St. Louis, MO, United States
| | - Matthew W Kreuter
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, 1 Brookings Dr, Campus Box 1196, 63130, St. Louis, MO, United States
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Food insecurity, social needs, and smoking status among patients in a county hospital system. Prev Med Rep 2022; 29:101963. [PMID: 36161141 PMCID: PMC9502041 DOI: 10.1016/j.pmedr.2022.101963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 12/05/2022] Open
Abstract
Tobacco use in the U.S. is increasingly concentrated among populations with socioeconomic disadvantages such as food insecurity. Building on prior studies showing that food insecurity increases odds of cigarette smoking, the current study sought to examine how food insecurity and other social needs, particularly financial strain, transportation barriers, and housing/utility insecurity, were associated with smoking status among adult patients seen in a county hospital system. We analyzed data from the electronic health record of patients from The MetroHealth System (Cleveland, Ohio, USA), covering a two-year period since implementation of social determinants of health assessments (2019–2021; N = 45,151 patients). Logistic regression analyses were used to examine associations with smoking status. Compared to the overall smoking prevalence (21 %), smoking was higher among patients screening for transportation barriers (41 %), financial strain (39 %), food insecurity (34 %), and housing/utility insecurity (27 %). Each of these social needs was independently associated with increased odds of current smoking (all p < 0.05). Smoking prevalence increased sequentially as the number of social needs increased; with each addition of a social need, there was a dose-response association with higher odds of current smoking (adjusted ORs ranged from 1.56 to 3.76, all p < 0.001), and current smoking specifically among ever smoking patients (adjusted ORs ranged from 1.39 to 3.01, all p < 0.001). There was substantial overlap among several social needs and smoking status. Alongside improving access to evidence-based cessation treatments and services, the findings raise the possibility that addressing social needs might reduce barriers to quitting and thereby reduce tobacco use disparities.
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Garg R, McQueen A, Evbuoma-Fike EI, Kreuter MW. Re-examining phone counseling for smoking cessation: Does the evidence apply to low-SES smokers? PATIENT EDUCATION AND COUNSELING 2022; 105:1783-1792. [PMID: 34815137 PMCID: PMC9110565 DOI: 10.1016/j.pec.2021.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/09/2021] [Accepted: 11/08/2021] [Indexed: 07/04/2023]
Abstract
INTRODUCTION A 2019 Cochrane review concluded telephone counseling is an effective intervention for smoking cessation. However, the review did not assess the role of socioeconomic status (SES) indicators on the effectiveness of telephone counseling. METHODS We reviewed 65 U.S. studies from the Cochrane review. We abstracted data on education, income, employment status and insurance status, and examined associations with targeted recruitment, intervention uptake, attrition, and cessation outcomes. RESULTS Except for education, SES indicators were seldom reported or used in analysis: 61 studies reported education, 24 reported insurance status, 23 reported employment status, and 17 reported income. Nine studies exclusively recruited low-SES samples. Thirteen studies examined associations between SES and smoking cessation. Among these, two reported lower education predicted greater cessation and two reported higher education predicted greater cessation. Other studies found higher income (n = 2) or employment type (n = 1) predicted cessation. CONCLUSIONS Evidence supporting telephone counseling for cessation is less clear when applied to low-SES smokers. Future research should directly assess intervention effectiveness in this priority population. PRACTICE IMPLICATIONS Given the evidence, it may be hard to justify future studies not focusing on low-SES populations. Innovative counseling solutions from providers helping low-income smokers quit should be evaluated to inform best practice.
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Affiliation(s)
- Rachel Garg
- Brown School, Washington University in St. Louis, St. Louis, USA.
| | - Amy McQueen
- Brown School, Washington University in St. Louis, St. Louis, USA; School of Medicine, Washington University in St. Louis, St. Louis, USA
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Garg R, Muhammad SN, Cabassa LJ, McQueen A, Verdecias N, Greer R, Kreuter MW. Transportation and other social needs as markers of mental health conditions. JOURNAL OF TRANSPORT & HEALTH 2022; 25:101357. [PMID: 36407687 PMCID: PMC9667984 DOI: 10.1016/j.jth.2022.101357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Objective The study sought to determine whether reporting a history of depression, anxiety, PTSD, bipolar disorder, drug or alcohol use disorder, ADHD, schizophrenia, or current depressive symptoms was associated with requesting help for any of 12 social needs. Methods A community-based sample of 1,944 low-income adult smokers in Missouri who had called a telephone helpline for social needs were recruited between June 1, 2017 and November 15, 2020. Helpline data on callers' requests for assistance with utilities, housing, food, household goods, healthcare, transportation, adult care, financial assistance, employment, legal assistance, personal safety and childcare were merged with self-reported mental health data collected in a subsequent phone survey with the same callers. Using binary logistic regression, we examined which mental health conditions were associated with each social need. Results Reporting mental health conditions were associated with greater odds of requests for assistance with transportation, food, healthcare and personal safety. Of these, the strongest and most consistent associations were with transportation needs. In post-hoc analyses, most associations between transportation needs and mental health remained significant after adjusting for possible confounders. Conclusions Compared to participants who did not report histories of mental health conditions, those who reported mental health conditions were more likely to call 2-1-1 seeking transportation assistance. Community-based agencies providing transportation or mental health services could partner to provide linkages between services and increase capacity to address transportation and mental health needs.
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Affiliation(s)
- Rachel Garg
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, United States
| | | | - Leopoldo J. Cabassa
- Center for Mental Health Services Research, Brown School at Washington University in St. Louis, St. Louis, MO, United States
| | - Amy McQueen
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, United States
- Division of General Medical Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Niko Verdecias
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, United States
| | - Regina Greer
- United Way of Greater St. Louis and 2-1-1 Missouri, St. Louis, MO, United States
| | - Matthew W. Kreuter
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, United States
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Garg R, Croston MA, Thompson T, McQueen A, Kreuter MW. Correlates of smoking discarded cigarettes in a sample of low-income adults. Addict Behav 2022; 128:107237. [PMID: 35074637 PMCID: PMC9137428 DOI: 10.1016/j.addbeh.2022.107237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/03/2022] [Accepted: 01/08/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Unconventional smoking behaviors such as smoking used or discarded cigarettes may increase the risk of nicotine dependence and exposure to toxins. To better understand low-income smokers who smoke discarded cigarettes and to inform effective tobacco cessation strategies, the current study examined potential correlates not considered in prior studies. METHODS This secondary analysis examined baseline data from 1936 low-income smokers participating in a randomized cessation trial. To assess smoking discarded cigarettes, participants were asked: "In the past 30 days, have you smoked what's left of a cigarette that someone else left behind?" Unadjusted and adjusted logistic regression were used to explore associations between smoking discarded cigarettes and social needs, social environment, mental and physical health, other smoking-related behaviors, and demographic characteristics. RESULTS One in six participants reported smoking discarded cigarettes. Younger smokers, men, smokers with lower incomes and those who were not employed were more likely to smoke discarded cigarettes. Other correlates included having unmet social needs (transportation, food, housing, physical safety, and neighborhood safety), living with other smokers, worse mental health, greater perceived stress, heavier smoking, using other tobacco products, and bumming cigarettes from others. In a multivariable model, income, social environment, and other smoking behaviors emerged as significant correlates. CONCLUSIONS In addition to financial hardship, mental health, and nicotine dependence, the social needs, social environment, and other smoking behaviors of low-income smokers are important correlates of smoking discarded cigarettes. Future research to understand and address tobacco health disparities should examine these relationships longitudinally.
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Jones SM, Heffner JL. Financial anxiety: a potential new target to increase smoking cessation. Future Oncol 2022; 18:1035-1038. [PMID: 35132901 DOI: 10.2217/fon-2021-1570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Salene Mw Jones
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - Jaimee L Heffner
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
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"When I Don't Have a Cigarette It's Helpful, but It Really Don't Satisfy:" Qualitative Study of Electronic Nicotine Delivery Systems (ENDS) Use among Low-Income Smokers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031157. [PMID: 35162181 PMCID: PMC8834368 DOI: 10.3390/ijerph19031157] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/06/2022] [Accepted: 01/13/2022] [Indexed: 02/01/2023]
Abstract
Background: Little is known about the use of electronic nicotine delivery systems (ENDS) among low-income adult cigarette smokers, who experience severe tobacco-related health disparities. Methods: This study conducted interviews to examine experiences and perceptions associated with ENDS use among predominantly low-income adult smokers (n = 30; mean age 30.2 ± 12.9; 60% male, 46.7% African American, 30% white, 10% more than one race; 76.7% annual household income ≤USD 24,000). Interviews were transcribed verbatim and coded in NVivo 11. Results: Overall, participants reported complementing rather than substituting their smoking with ENDS use (e.g., using ENDS only when smoking is not allowed). Predominant reasons for vaping were convenience, smoking reduction/cessation, stress management, social acceptability, lower long-term costs than smoking, and appealing flavors. Common reasons for not switching to exclusive vaping were that ENDS did not satisfy cigarette cravings and concerns about ENDS health effects. Participants indicated higher likelihood of switching to exclusive ENDS use if the products were more affordable, perceived as substantially less harmful, tasted and felt more like smoking a cigarette, and more effective for reducing cravings. Conclusions: Continued research is needed to maximize any harm reduction potential of ENDS and ensure that these products do not contribute to worsening health disparities.
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Garg R, McQueen A, Roberts C, Butler T, Grimes LM, Thompson T, Caburnay C, Wolff J, Javed I, Carpenter KM, Wartts JG, Charles C, Howard V, Kreuter MW. Stress, depression, sleep problems and unmet social needs: Baseline characteristics of low-income smokers in a randomized cessation trial. Contemp Clin Trials Commun 2021; 24:100857. [PMID: 34849423 PMCID: PMC8609143 DOI: 10.1016/j.conctc.2021.100857] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 09/20/2021] [Accepted: 11/09/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Low-income Americans smoke cigarettes at higher rates and quit less than other groups. METHODS To increase their engagement in and success using evidence-based cessation methods, we tested two interventions using a 2x2 randomized factorial design: (1) telephone navigation to reduce financial strain and address social needs such as food, rent and utility payment; and (2) a specialized tobacco quitline designed for low-income smokers. From June 2017 to November 2020, we enrolled 1,944 low-income smokers in Missouri, USA, recruited through the Missouri 2-1-1 helpline, into the trial. This paper describes recruitment, key characteristics and life circumstances of this high-risk population. RESULTS After eligibility screening, 1,944 participants completed baseline and were randomized. Participants were racially diverse (58% African American), poor (51% < $10,000 annual pre-tax household income) and many reported less than high school education (30%). They reported a mean of 2.5 unmet social needs, especially childcare and paying bills, had high rates of stress, depressive symptoms and sleep problems, and most were in fair or poor health. There were few differences between these variables, and no differences between tobacco use and cessation variables, across the four study groups and between participants recruited pre and during the COVID-19 pandemic. CONCLUSIONS Trial recruitment through the 2-1-1 helpline is feasible for reaching a population of low-income smokers. Low-income smokers face myriad daily challenges beyond quitting smoking. Cessation interventions need to account for and address these life circumstances. TRIAL REGISTRATION Clinicaltrials.gov NCT03194958.
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Affiliation(s)
- Rachel Garg
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Amy McQueen
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
- Division of General Medical Sciences, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Christina Roberts
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Taylor Butler
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Lauren M. Grimes
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Tess Thompson
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Charlene Caburnay
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Jennifer Wolff
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Irum Javed
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | | | - Jordyn G. Wartts
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Cindy Charles
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Valerie Howard
- Tobacco Prevention and Control Program, Missouri Department of Health and Senior Services, Jefferson City, MO, USA
| | - Matthew W. Kreuter
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
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14
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Verdecias N, Garg R, Steensma J, McQueen A, Greer R, Kreuter MW. Expressed and unexpressed social needs in low-income adults in the U.S. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:e184-e191. [PMID: 33378603 PMCID: PMC8243392 DOI: 10.1111/hsc.13265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/09/2020] [Accepted: 12/01/2020] [Indexed: 06/01/2023]
Abstract
Many healthcare organisations are now routinely screening patients for social needs such as food and housing. It is largely unknown whether the needs they identify would have been expressed by the patient in the absence of screening. To better understand expressed and unexpressed social needs, we administered a social needs screener to 1,397 low-income adults who called a 2-1-1 helpline in Missouri seeking assistance with social needs between June 2017 and October 2019. Merging data from the screener and 2-1-1, we found that the screener identified all of the social needs expressed to 2-1-1 for about half the participants, and on average identified at least one social need not expressed to 2-1-1 (i.e., unexpressed needs). Certain social needs (utility payment assistance, housing) were much more likely to be expressed than unexpressed, while others (childcare, employment, personal safety) were almost universally unexpressed. In regression analyses, having certain expressed needs significantly increased the odds of having certain unexpressed needs. For example, those seeking transportation assistance from 2-1-1 had greater odds of unexpressed needs for food (OR = 3.19; 95% CI = 1.45-7.02) and healthcare (OR = 2.18; 95% CI = 1.06-4.48) than those not expressing transportation needs. Those seeking employment assistance from 2-1-1 had greater odds of unexpressed needs for personal safety (OR = 3.04; 95% CI = 1.20-7.68) and healthcare (OR = 2.58; 95% CI = 1.15-5.77) than those not expressing employment needs. Implications for healthcare (screening detects expressed and unexpressed needs) and social service organisations (certain requests may be markers for other needs) are discussed.
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Affiliation(s)
- Niko Verdecias
- Washington University in St. Louis, Brown School, Health Communication Research Laboratory, St. Louis, MO
| | - Rachel Garg
- Washington University in St. Louis, Brown School, Health Communication Research Laboratory, St. Louis, MO
| | - Joe Steensma
- Washington University in St. Louis, Brown School, Health Communication Research Laboratory, St. Louis, MO
| | - Amy McQueen
- Washington University in St. Louis, Brown School, Health Communication Research Laboratory, St. Louis, MO
- Washington University in St. Louis, School of Medicine, St. Louis, MO
| | - Regina Greer
- United Way of Greater St. Louis 2-1-1, St. Louis, MO
| | - Matthew W. Kreuter
- Washington University in St. Louis, Brown School, Health Communication Research Laboratory, St. Louis, MO
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15
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McQueen A, Li L, Herrick CJ, Verdecias N, Brown DS, Broussard DJ, Smith RE, Kreuter M. Social Needs, Chronic Conditions, and Health Care Utilization among Medicaid Beneficiaries. Popul Health Manag 2021; 24:681-690. [PMID: 33989068 DOI: 10.1089/pop.2021.0065] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Health care organizations are increasingly assessing patients' social needs (eg, food, utilities, transportation) using various measures and methods. Prior studies have assessed social needs at the point of care and many studies have focused on correlates of 1 specific need (eg, food). This comprehensive study examined multiple social needs and medical and pharmacy claims data. Medicaid beneficiaries in Louisiana (n = 10,275) completed a self-report assessment of 10 social needs during July 2018 to June 2019. Chronic health conditions, unique medications, and health care utilization were coded from claims data. The sample was predominantly female (72%), Black (45%) or White (32%), had a mean age of 42 years, and at least 1 social need (55%). In bivariate analyses, having greater social needs was associated with greater comorbidity across conditions, and each social need was consistently associated with mental health and substance use disorders. In multivariable logistic analyses, having ≥2 social needs was positively associated with emergency department (ED) visits (OR = 1.39, CI = 1.23 - 1.57) and negatively associated with wellness visits (OR = 0.87, CI = 0.77 - 0.98), inpatient visits (OR = 0.87, CI = 0.76 - 0.99), and 30-day rehospitalization (OR = 0.66, CI = 0.50 - 0.87). Findings highlight the greater concomitant risk of social needs, mental health, and substance use. Admission policies may reduce the impact of social needs on hospitalization. Chronic disease management programs offered by health plans may benefit from systematically assessing and addressing social needs outside point-of-care interactions to impact health outcomes and ED utilization. Behavioral health care management programs would benefit from integrating interventions for multiple social needs.
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Affiliation(s)
- Amy McQueen
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA.,Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Linda Li
- Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Cynthia J Herrick
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Niko Verdecias
- Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Derek S Brown
- Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA
| | | | - Rachel E Smith
- Louisiana Healthcare Connections, Baton Rouge, Louisiana, USA
| | - Matthew Kreuter
- Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA
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16
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Kreuter MW, Thompson T, McQueen A, Garg R. Addressing Social Needs in Health Care Settings: Evidence, Challenges, and Opportunities for Public Health. Annu Rev Public Health 2021; 42:329-344. [PMID: 33326298 PMCID: PMC8240195 DOI: 10.1146/annurev-publhealth-090419-102204] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
There has been an explosion of interest in addressing social needs in health care settings. Some efforts, such as screening patients for social needs and connecting them to needed social services, are already in widespread practice. These and other major investments from the health care sector hint at the potential for new multisector collaborations to address social determinants of health and individual social needs. This article discusses the rapidly growing body of research describing the links between social needs and health and the impact of social needs interventions on health improvement, utilization, and costs. We also identify gaps in the knowledge base and implementation challenges to be overcome. We conclude that complementary partnerships among the health care, public health, and social services sectors can build on current momentum to strengthen social safety net policies, modernize social services, and reshape resource allocation to address social determinants of health.
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Affiliation(s)
- Matthew W Kreuter
- The Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , , ,
| | - Tess Thompson
- The Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , , ,
| | - Amy McQueen
- The Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , , ,
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri 63110, USA
| | - Rachel Garg
- The Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , , ,
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17
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Kuroki L, Massad LS, Martin A, Liu J, Brown D, Leon A, Groesch K, Wilson T, Zeino Y, Diaz-Sylvester P, Delfino K, Hyon K, Kreuter M. Addressing Unmet Basic Needs to Improve Colposcopy Adherence Among Women With Abnormal Cervical Cancer Screening. J Low Genit Tract Dis 2021; 25:106-112. [PMID: 33631781 PMCID: PMC7987876 DOI: 10.1097/lgt.0000000000000593] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of the study were to identify unmet basic needs (BNs) among women referred to colposcopy, to assess patient acceptability/satisfaction with assistance from a navigator to address unmet BNs, and to estimate adherence to colposcopy. METHODS Women were recruited between September 2017 and January 2019 from 2 academic colposcopy centers, one serving a rural and one an urban area. Basic needs were assessed by phone before colposcopy appointments and considered unmet if unlikely to resolve in 1 month. Colposcopy adherence prestudy and poststudy implementation was abstracted over 4-6 months from administrative records. After a lead-in phase of 25 patients at each site, a BN navigator was offered to new participants with 1 or more unmet BNs. Primary outcome was adherence to initial appointment. RESULTS Among 100 women, 59% had 1 or more unmet BNs, with similar prevalence between urban and rural sites. Adherence to initial colposcopy was 83% overall, 72% at the rural clinic, and 94% at the urban clinic (p = .006). These adherence rates were improved from 4 months before study launch (30/59 [51%] rural clinic and 68/137 [50%] urban clinic). Although acceptability of BN navigation was greater than 96% and women felt that it helped them get to their colposcopy visit, having a navigator was not associated with adherence. Women reporting no unmet BNs had the lowest adherence compared with women with 1 or more unmet BNs, regardless of navigator assistance (p = .03). CONCLUSIONS Disadvantaged women who need colposcopy have unmet BNs and value navigator assistance for initial appointments. However, when appointment scheduling includes telephone reminders and inquiring about BNs, a navigator may not add value.
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Affiliation(s)
- Lindsay Kuroki
- Division of Gynecologic Oncology, Washington University School of Medicine, Alvin J. Siteman Cancer Center, St Louis, MO
| | - L Stewart Massad
- Division of Gynecologic Oncology, Washington University School of Medicine, Alvin J. Siteman Cancer Center, St Louis, MO
| | - Anne Martin
- Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine (SIUM), Springfield, IL
| | - Jingxia Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Dominique Brown
- Health Communication Research Laboratory, The Brown School, Washington University in St Louis, St Louis, MO
| | - Andrea Leon
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO
| | | | | | - Yahia Zeino
- Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine (SIUM), Springfield, IL
| | | | | | - Katherine Hyon
- Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine (SIUM), Springfield, IL
| | - Matthew Kreuter
- Health Communication Research Laboratory, The Brown School, Washington University in St Louis, St Louis, MO
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18
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Comparing two approaches to remote biochemical verification of self-reported cessation in very low-income smokers. Addict Behav Rep 2021; 13:100343. [PMID: 33786362 PMCID: PMC7988487 DOI: 10.1016/j.abrep.2021.100343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/21/2022] Open
Abstract
Little is known about the acceptability and use of remote biochemical verification of self-reported cessation among low-income and racially diverse smokers. We compared responses to an in-person carbon monoxide breath test and in-home urine cotinine test among 270 adults who reported 7-day continuous abstinence at 6-month follow-up in a community-based randomized cessation trial. Half of participants (50%) reported annual household income below $10,000, one in four (28%) had not completed high school, and 69% were Black or African American. Regardless of whether the two tests were offered separately, sequentially, or as a head-to-head choice, participants were more likely to accept an offer to take the urine test than the breath test (89% vs. 32%), and complete it (46% vs. 13%). The proportion of participants completing the urine test and returning a digital photo of the test result is comparable to several studies completed with less disadvantaged samples. Self-report was confirmed by urine test for 74% of participants with a conclusive test result, although a high percentage (39%) of test results were inconclusive. In-home urine testing appears both acceptable and feasible for many low-income smokers, but challenges with testing technology and response rates currently limit its value to increase confidence in self-reports.
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19
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Thompson T, Pérez M, Yan Y, Kreuter MW, Margenthaler JA, Colditz GA, Jeffe DB. Randomized controlled trial of a breast cancer Survivor Stories intervention for African American women. Soc Sci Med 2021; 270:113663. [PMID: 33454539 PMCID: PMC8173764 DOI: 10.1016/j.socscimed.2020.113663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/08/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
RATIONALE Video-based interventions hold promise for improving quality of life (QoL) among African American breast cancer patients. OBJECTIVE An interactive, cancer-communication intervention using African American breast cancer survivors' narratives was tested in a randomized controlled trial to determine whether viewing survivor stories improved newly diagnosed African American breast cancer patients' QoL. METHOD Participants were 228 African American women with non-metastatic breast cancer interviewed five times over two years; 120 controls received standard medical care, and 108 intervention-arm participants also received a tablet-computer with survivor stories three times in 12 months. Growth curve models were used to analyze differences between arms in change in eight RAND 36-Item Health Survey subscales, depressive symptoms, and concerns about recurrence. Additional models explored the effects of intervention usage and other intervention-related variables on QoL among patients in the intervention arm. RESULTS Models showed no effect of study arm on QoL, depressive symptoms, or concerns about recurrence. Longer use of the intervention was associated with an increase in concerns about recurrence and decline in three QoL subscales: emotional wellbeing, energy/fatigue, and role limitations due to physical health. CONCLUSION Although no significant impact of the intervention on QoL was observed when comparing the two study arms, in the intervention arm longer intervention use was associated with declines in three QoL subscales and increased concerns about recurrence. Women with improving QoL may have interacted with the tablet less because they felt less in need of information; it is also possible that encouraging patients to compare themselves to survivors who had already recovered from breast cancer led some patients to report lower QoL. Future work is warranted to examine whether adding different stories to this cancer-communication intervention or using stories in conjunction with additional health promotion strategies (e.g., patient navigation) might improve QoL for African American breast cancer patients.
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Affiliation(s)
- Tess Thompson
- Brown School of Social Work, Washington University in St. Louis, USA.
| | - Maria Pérez
- Washington University School of Medicine, USA
| | - Yan Yan
- Washington University School of Medicine, USA
| | - Matthew W Kreuter
- Brown School of Social Work, Washington University in St. Louis, USA
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20
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Flocke SA, Seeholzer E, Lewis SA, Gill IJ, Rose JC, Albert E, Love TE, Kaelber D. 12-Month Evaluation of an EHR-Supported Staff Role Change for Provision of Tobacco Cessation Care in 8 Primary Care Safety-Net Clinics. J Gen Intern Med 2020; 35:3234-3242. [PMID: 32705473 PMCID: PMC7661631 DOI: 10.1007/s11606-020-06030-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
SIGNIFICANCE Guidelines urge primary care practices to routinely provide tobacco cessation care (i.e., assess tobacco use, provide brief cessation advice, and refer to cessation support). This study evaluates the impact of a systems-based strategy to provide tobacco cessation care in eight primary care clinics serving low-income patients. METHODS A non-randomized stepped wedge study design was used to implement an intervention consisting of (1) changes to the electronic health record (EHR) referral functionality and (2) expansion of staff roles to provide brief advice to quit; assess readiness to quit; offer a referral to tobacco cessation counseling; and sign the referral order. Outcomes assessed from the EHR include performance of tobacco cessation care tasks, referral contact, and enrollment rates for the quitline (QL) and in-house Freedom from Smoking (FFS) program. Generalized estimating equations (GEE) methods were used to compute odds ratios contrasting the pre-implementation vs. 1-, 3-, 6-, and 12-month post-implementation periods. RESULTS Of the 176,061 visits, 26.1% were by identified tobacco users. All indicators significantly increased at each time period evaluated post-implementation. In comparison with the pre-intervention period, assessing smoking status (26.6% vs. 55.7%; OR = 3.7, CI = 3.6-3.9), providing advice (44.8% vs. 88.7%; OR = 7.8, CI = 6.6-9.1), assessing readiness to quit (15.8% vs. 55.0%; OR = 6.2, CI = 5.4-7.0), and acceptance of a referral to tobacco cessation counseling (0.5% vs. 30.9%; OR = 81.0, CI = 11.4-575.8) remained significantly higher 12 months post-intervention. For the QL and FFS, respectively, there were 1223 and 532 referrals; 324 (31.1%) and 103 (24.7%) were contacted; 241 (74.4%) and 72 (69.6%) enrolled; and 195 (80.9%) and 14 (19.4%) received at least one counseling session. CONCLUSIONS This system change intervention that includes an EHR-supported role expansion substantially increased the provision of tobacco cessation care and improvements were sustained beyond 1 year. This approach has the potential to greatly increase the number of individuals referred for tobacco cessation counseling.
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Affiliation(s)
- Susan A Flocke
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA.
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA.
| | - Eileen Seeholzer
- Center for Health Care Research and Policy, The MetroHealth System, Cleveland, OH, USA
| | - Steven A Lewis
- Center for Health Care Research and Policy, The MetroHealth System, Cleveland, OH, USA
| | - India J Gill
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA
- Departments of Medicine and Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Jeanmarie C Rose
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA
| | - Elizabeth Albert
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA
| | - Thomas E Love
- Center for Health Care Research and Policy, The MetroHealth System, Cleveland, OH, USA
- Departments of Medicine and Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - David Kaelber
- Center for Health Care Research and Policy, The MetroHealth System, Cleveland, OH, USA
- Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH, USA
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21
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Kreuter MW, Garg R, Li L, McNulty L, Thompson T, McQueen A, Luke AA. How Do Social Needs Cluster Among Low-Income Individuals? Popul Health Manag 2020; 24:322-332. [PMID: 32877298 DOI: 10.1089/pop.2020.0107] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Social needs screening in health care settings reveals that many low-income individuals have multiple unmet social needs at the same time. Having multiple simultaneous social needs greatly increases the odds of experiencing adverse health outcomes. To better understand how and which social needs cluster in these cases, the authors examined data from 14,749 low-income adults who completed a social needs assessment in one of 4 separate studies conducted between 2008 and 2019 in the United States. Participants were Medicaid beneficiaries, helpline callers, and daily smokers. Findings were strikingly consistent across the 4 studies. Participants with ≥2 social needs (n = 5621; 38% of total) experienced more stress, depressive symptoms, sleep problems, and chronic diseases and were more likely to rate their health as fair or poor. Social needs reflecting financial strain were highly correlated, such as needing help paying utility bills and needing money for necessities such as food, shelter, and clothing (r = .49 to .71 across studies). Participants experienced 351 distinct combinations of ≥2 social needs. The 10 most common combinations accounted for more than half of all participants with ≥2 needs. Clusters of social needs varied by subgroups. Women with children were more likely than others to need more space in their home and help paying utility bills; low-income men were more likely to be physically threatened and need a place to stay; older, sicker adults were more likely to need money for necessities and unexpected expenses, as well as transportation. Findings are discussed in the context of creating smarter, more efficient social needs interventions.
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Affiliation(s)
- Matthew W Kreuter
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Rachel Garg
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Linda Li
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Laura McNulty
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Tess Thompson
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Amy McQueen
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA.,Division of General Medical Sciences, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Alina A Luke
- Cardiovascular Division, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
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22
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Albert EL, Rose JC, Gill IJ, Flocke SA. Quitting the quitline: a qualitative study of patient experience of electronic referrals to quitlines. BMC Public Health 2020; 20:1080. [PMID: 32646397 PMCID: PMC7350715 DOI: 10.1186/s12889-020-09185-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The use of electronic referrals (eReferrals) to state quitlines (QLs) for tobacco-using patients is a promising approach for addressing smoking cessation on a large scale. However, QL contact, enrollment, and completion rates are low. The purpose of this study was to examine the eReferral to QL process from the patient's perspective in order to inform strategies for improving QL engagement. METHODS We conducted interviews with 55 patients who agreed to an eReferral at a primary care visit to 1 of 8 safety-net community health centers in Cuyahoga County, Ohio (September 2017-August 2018). Interviews were designed to explore the experiences of three subgroups of patients who subsequently: 1) declined participation in the QL; 2) were unreachable by the QL; or 3) were enrolled in or had completed the QL program. Analysis was guided by a phenomenological approach designed to identify emergent themes. RESULTS Reasons for QL program non-completion included changing life circumstances and events making cessation unviable; misunderstandings about the QL; discomfort with telephonic counseling; perceived lack of time for counseling; cell phone barriers; and having already quit smoking. We found that some individuals who were no longer engaged with the QL still desired continued support from the QL. CONCLUSIONS Participants intentionally and unintentionally disengage from the QL for a wide variety of reasons, several of which are mediated by low socioeconomic status. Integrating QL care with community-based resources that address these mediators could be a promising strategy.
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Affiliation(s)
- Elizabeth L Albert
- Center for Community Health Integration, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-7136, USA.
| | - Jeanmarie C Rose
- Center for Community Health Integration, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-7136, USA
| | - India J Gill
- Center for Community Health Integration, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-7136, USA
| | - Susan A Flocke
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, 97239, USA
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23
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Jones AM, Carter-Harris L, Stiffler D, Macy JT, Staten LK, Shieh C. Smoking Status and Symptoms of Depression During and After Pregnancy Among Low-Income Women. J Obstet Gynecol Neonatal Nurs 2020; 49:361-372. [PMID: 32561271 DOI: 10.1016/j.jogn.2020.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To describe the point prevalence rates, relapse rates, smoking status, and symptoms of depression and to examine the relationship between smoking status and symptoms of depression from early pregnancy to 12 months after childbirth among low-income women. DESIGN Secondary data analysis. SETTING Data from the national Nurse-Family Partnership program. PARTICIPANTS Women who were enrolled in the national Nurse-Family Partnership program between 2011 and 2016 with histories of smoking 3 months before pregnancy (N = 1,554). METHODS We used smoking status and Edinburgh Postnatal Depression Scale scores in early pregnancy, late pregnancy, and 12 months after childbirth to identify point prevalence rates, relapse rates, smoking status, and symptoms of depression. We used chi-square and additional analyses to examine the relationship between smoking status and symptoms of depression. RESULTS The prevalence of smoking was 30.12% (n = 468) in early pregnancy, 24.39% (n = 379) in late pregnancy, and 50.58% (n = 786) 12 months after childbirth. Prevalence rates of a positive depression screening result were 30.31% (n = 471), 20.46% (n = 318), and 18.08% (n = 281), respectively. Smoking relapse rates were 2.45% (n = 38) during the third trimester and 27.86% (n = 433) at 12 months after childbirth. Eight distinct patterns of smoking and depression were identified. Women who smoked were significantly more likely to also have positive depression screening results during the third trimester and at 12 months after childbirth compared with nonsmoking women (OR = 1.37, 95% confidence interval [1.04, 1.81] and OR = 1.93, 95% confidence interval [1.47, 2.51], respectively). CONCLUSION Prevalence rates of smoking, relapse, and positive depression screening results were great in this sample of low-income women during and after pregnancy. Pivotal time points exist where the trajectory of smoking and depression screening patterns may change. It is important for smoking cessation interventions to incorporate mental health assessment and treatment.
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