title: Proactive tobacco treatment offering free nicotine replacement therapy and telephone counselling for socioeconomically disadvantaged smokers: a randomised clinical trial.
abstract: BACKGROUND
  Evidenced-based tobacco cessation treatments are underused, especially by socioeconomically disadvantaged smokers. This contributes to widening socioeconomic disparities in tobacco-related morbidity and mortality.
  
  
  METHODS
  The Offering Proactive Treatment Intervention trial tested the effects of a proactive outreach tobacco treatment intervention on population-level smoking abstinence and tobacco treatment use among a population-based sample of socioeconomically disadvantaged smokers. Current smokers (n=2406), regardless of interest in quitting, who were enrolled in the Minnesota Health Care Programs, the state's publicly funded healthcare programmes for low-income populations, were randomly assigned to proactive outreach or usual care. The intervention comprised proactive outreach (tailored mailings and telephone calls) and free cessation treatment (nicotine replacement therapy and intensive, telephone counselling). Usual care comprised access to a primary care physician, insurance coverage of Food and Drug Administration-approved smoking cessation medications, and the state's telephone quitline. The primary outcome was self-reported 6-month prolonged smoking abstinence at 1 year and was assessed by follow-up survey.
  
  
  RESULTS
  The proactive intervention group had a higher prolonged abstinence rate at 1 year than usual care (16.5% vs 12.1%, OR 1.47, 95% CI 1.12 to 1.93). The effect of the proactive intervention on prolonged abstinence persisted in selection models accounting for non-response. In analysis of secondary outcomes, use of evidence-based tobacco cessation treatments were significantly greater among proactive outreach participants compared with usual care, particularly combination counselling and medications (17.4% vs 3.6%, OR 5.69, 95% CI 3.85 to 8.40).
  
  
  CONCLUSIONS
  Population-based proactive tobacco treatment increases engagement in evidence-based treatment and is effective in long-term smoking cessation among socioeconomically disadvantaged smokers. Findings suggest that dissemination of population-based proactive treatment approaches is an effective strategy to reduce the prevalence of smoking and socioeconomic disparities in tobacco use.
  
  
  BACKGROUND
  NCT01123967.
authors.affiliation: VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
authors.forename: Steven S
authors.initials: SS
authors.lastname: Fu
authors.affiliation: Division of Health Care Policy & Research, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: van Ryn
authors.affiliation: VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
authors.forename: David
authors.initials: D
authors.lastname: Nelson
authors.affiliation: VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
authors.forename: Diana J
authors.initials: DJ
authors.lastname: Burgess
authors.affiliation: Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
authors.forename: Janet L
authors.initials: JL
authors.lastname: Thomas
authors.affiliation: North American Quitline Consortium, Phoenix, Arizona, USA.
authors.forename: Jessie
authors.initials: J
authors.lastname: Saul
authors.affiliation: VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis, Minnesota, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Clothier
authors.affiliation: Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Nyman
authors.affiliation: Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Hammett
authors.affiliation: Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Joseph
mesh_terms: D000293:Adolescent; D000328:Adult; D003376:Counseling; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D011203:Poverty; D016540:Smoking Cessation / Q000379:methods*; D013689:Telephone; D061485:Tobacco Use Cessation Devices; D014029:Tobacco Use Disorder / Q000628:therapy*; D016896:Treatment Outcome; D035862:Vulnerable Populations
keywords: Smoking cessation; Tobacco control