Employment, gender, and smoking cessation outcomes in low-income smokers using nicotine replacement therapy.
BACKGROUND
This study examines the presence and correlates of gender disparities in smoking cessation among lower income smokers prescribed nicotine replacement medication.


METHODS
We examined quit rates (7-day abstinence point prevalence) among a cohort of smokers who filled prescriptions for nicotine replacement (N = 1,782), using Minnesota Health Care Programs' (e.g., Medicaid) pharmacy claims databases (2005-2006) and mixed-mode survey protocols. A cohort of smokers who recently filled a prescription for nicotine replacement was stratified by race, and then subjects were selected by simple random sample from each race, oversampling the nonWhite groups (N = 1,782). The primary outcome was point prevalence of 7-day abstinence, and outcomes were assessed about 8 months after the nicotine replacement therapy (NRT) index prescription fill date using a mixed-mode survey protocol. Final interaction models were constructed using backward elimination.


RESULTS
Abstinence rates were 11.4% among women and 19.2% among men (p = .02) and remained marginally significant after controlling for demographics, mental and physical health, period of cigarette abstinence, social environment, religious attendance, perceived stress, and NRT prescription type (p = .08). There was a significant Gender x Employment interaction (p = .02). Among men, quit rates were higher among the employed (26%) compared with the unemployed (16%); among women, quit rates were lower among those who were employed (8%) compared with those who were unemployed (14%).


CONCLUSIONS
Results suggest the need for research on factors specific to women's work roles or workplaces that inhibit cessation as well as cessation programs tailored to low-income, employed female smokers. On-site workplace interventions and flexible counseling programs may be especially beneficial.
Burgess
Diana J
DJ
Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN 55417, USA. diana.burgess@va.gov
Fu
Steven S
SS
Noorbaloochi
Siamak
S
Clothier
Barbara A
BA
Ricards
Jennifer
J
Widome
Rachel
R
van Ryn
Michelle
M
D000328:Adult; D015331:Cohort Studies; D003376:Counseling / Q000458:organization & administration; D004651:Employment / Q000458:organization & administration* / Q000523:psychology; D005260:Female; D006293:Health Promotion / Q000458:organization & administration; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D009538:Nicotine / Q000627:therapeutic use; D018722:Nicotinic Agonists / Q000627:therapeutic use; D011203:Poverty / Q000706:statistics & numerical data*; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology / Q000523:psychology*; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology* / Q000706:statistics & numerical data; D000074606:Smoking Prevention; D012931:Social Environment; D014029:Tobacco Use Disorder / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome; D016387:Women's Health; D017132:Workplace / Q000458:organization & administration; D055815:Young Adult
D018722:Nicotinic Agonists; D009538:Nicotine