title: Tobacco cessation among low-income smokers: motivational enhancement and nicotine patch treatment.
abstract: BACKGROUND
  Despite decades of tobacco use decline among the general population in the United States, tobacco use among low-income populations continues to be a major public health concern. Smoking rates are higher among individuals with less than a high school education, those with no health insurance, and among individuals living below the federal poverty level. Despite these disparities, smoking cessation treatments for low-income populations have not been extensively tested. In the current study, the efficacy of 2 adjunctive smoking cessation interventions was evaluated among low-income smokers who were seen in a primary care setting.
  
  
  METHODS
  A total of 846 participants were randomly assigned either to motivational enhancement treatment plus brief physician advice and 8 weeks of nicotine replacement therapy (NRT) or to standard care, which consisted of brief physician advice and 8 weeks of NRT. Tobacco smoking abstinence was at 1, 2, 6, and 12 months following baseline.
  
  
  RESULTS
  The use of the nicotine patch, telephone counseling, and positive decisional balance were predictive of increased abstinence rates, and elevated stress levels and temptation to smoke in both social/habit and negative affect situations decreased abstinence rates across time. Analyses showed intervention effects on smoking temptations, length of patch use, and number of telephone contacts. Direct intervention effects on abstinence rates were not significant, after adjusting for model predictors and selection bias due to perirandomization attrition.
  
  
  CONCLUSIONS
  Integrating therapeutic approaches that promote use of and adherence to medications for quitting smoking and that target stress management and reducing negative affect may enhance smoking cessation among low-income smokers.
authors.affiliation: Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI;
authors.forename: Beth C
authors.initials: BC
authors.lastname: Bock
authors.forename: George D
authors.initials: GD
authors.lastname: Papandonatos
authors.forename: Marcel A
authors.initials: MA
authors.lastname: de Dios
authors.forename: David B
authors.initials: DB
authors.lastname: Abrams
authors.forename: Munawar M
authors.initials: MM
authors.lastname: Azam
authors.forename: Mark
authors.initials: M
authors.lastname: Fagan
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Sweeney
authors.forename: Michael D
authors.initials: MD
authors.lastname: Stein
authors.forename: Raymond
authors.initials: R
authors.lastname: Niaura
mesh_terms: D000328:Adult; D003376:Counseling; D005260:Female; D006293:Health Promotion / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009538:Nicotine / Q000008:administration & dosage; D011203:Poverty; D012907:Smoking / Q000188:drug therapy* / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods*; D061485:Tobacco Use Cessation Devices; D014029:Tobacco Use Disorder / Q000188:drug therapy / Q000523:psychology; D014481:United States
chemical_list: D009538:Nicotine