Brown School researchers begin low-income smoker study

Brown School researchers at Washington University in St. Louis have begun work on a five-year, $3.9 million study that tests an innovative approach to help low-income smokers quit.

Matthew Kreuter, the Kahn Family Professor of Public Health, is leading the effort. Amy McQueen is the study’s co-leader and co-director of the Health Communication Research Laboratory, where the research is based.

Funded by the National Cancer Institute at the National Institutes of Health (NIH), the study began in July and will recruit nearly 2,000 low-income smokers from nine states where smoking rates exceed the national average of 15%.

“There is an urgent need to get more low-income smokers engaged in activities that will help them to quit someday,” Kreuter said. “The current approach works for those who use it, but doesn’t reach nearly enough people.”

Matthew Kreuter

As a part of the large-scale study, half of participants will be offered the current standard for population-level treatment, cessation counseling with a quit coach through state telephone quit-smoking hotlines. A notable limitation of this approach is that to be eligible, smokers must plan to quit in the next 30 days. That requirement disqualifies 70% to 80% of low-income smokers.

Here, the other half of participants also will be offered quit-smoking line services, but those who don’t plan to quit in the next 30 days will then be offered an alternative: a proven program to help them establish rules banning smoking inside their homes.

Previous studies have shown that creating a smoke-free home reduces health risks to nonsmokers and ultimately helps smokers quit.

The study involves collaborators from Emory University; Optum, a quitline provider that will assist in providing the cessation and Smoke Free Homes interventions to participants; and 2-1-1 helplines, which will connect researchers with 1,980 low-income smokers from states with high smoking prevalence.

Researchers first conducted three pilot studies to investigate this approach. The researchers concluded that certain factors play a role in the effectiveness of the study’s approach: smokers’ readiness to quit; motivation to protect children and nonsmokers; and acceptance of a smoke-free home intervention.

Smokers participating in the study will be followed for six months. The study will examine differences in cigarettes smoked per day; attempts to quit smoking; and success in creating a smoke-free home. The goal is to assist those with limited income and resources in the process of quitting the deadly habit.

“Offering smokers another service besides quitting could help more people make incremental changes that pave the way to greater cessation rates down the road,” McQueen said.

Smoking rates in the U.S. are much higher among those in living in poverty. Those who receive health care through Medicaid, the uninsured, those with lower levels of education and people who have serious psychological stress also have  higher smoking rates. Smoking-related cancers are more common and are diagnosed at a later stage in low-income and low-education populations.