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. 2012 Mar;102(3):e8-16.
doi: 10.2105/AJPH.2011.300519. Epub 2012 Jan 19.

Socioeconomic disparities in community-based treatment of tobacco dependence

Christine E Sheffer  1 , Maxine Stitzer, Reid Landes, S Laney Brackman, Tiffany Munn, Page Moore
Affiliations

Socioeconomic disparities in community-based treatment of tobacco dependence

Christine E Sheffer et al. Am J Public Health. 2012 Mar.

Abstract

Objectives: We examined socioeconomic disparities in a community-based tobacco dependence treatment program.

Methods: We provided cognitive-behavioral treatment and nicotine patches to 2739 smokers. We examined treatment use, clinical and environmental, and treatment outcome differences by socioeconomic status (SES). We used logistic regressions to model end-of-treatment and 3- and 6-month treatment outcomes.

Results: The probability of abstinence 3 months after treatment was 55% greater for the highest-SES than for the lowest-SES (adjusted odds ratio [AOR] = 1.55; 95% confidence interval [CI] = 1.03, 2.33) smokers and increased to 2.5 times greater for the highest-SES than for the lowest-SES smokers 6 months after treatment (AOR = 2.47; 95% CI = 1.62, 3.77). Lower-SES participants received less treatment content and had fewer resources and environmental supports to manage a greater number of clinical and environmental challenges to abstinence.

Conclusions: Targets for enhancing therapeutic approaches for lower socioeconomic groups should include efforts to ensure that lower-SES groups receive more treatment content, strategies to address specific clinical and environmental challenges associated with treatment outcomes for lower-SES smokers (i.e., higher dependence and stress levels and exposure to other smokers), and strategies to provide longer-term support.

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Figures

FIGURE 1—
FIGURE 1—
Abstinence rates by SES measured with a composite index that incorporated values for household income and educational level with a range from 2 (lowest)–10 (highest): community-based tobacco dependence treatment program, Arkansas, 2005–2008. Note. SES = socioeconomic status. SES1 included values from 2–4, SES2 from 5–7, and SES3 from 8–10. SES was not significantly associated with end-of-treatment outcomes but was significantly associated with 3- and 6-month treatment outcomes. The sample size was n = 2739.
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