Impacts of a support intervention for low-income women who smoke

doi:10.1016/j.socscimed.2010.08.023

Social Science & Medicine

Volume 71, Issue 11, December 2010, Pages 1901-1909

https://doi.org/10.1016/j.socscimed.2010.08.023 Get rights and content

Abstract

The objective of this pilot study was to implement and evaluate the impact of a support intervention tailored to the assessed support needs, resources and preferences of low-income women who smoke in three Canadian cities. The support intervention, informed by theoretical foundations, provided holistic one-to-one and group support over 14 weeks. The support intervention was facilitated by trained professional and peer facilitators. The impact was evaluated through analysis of qualitative and quantitative data collected at pre-, post-, and delayed post-test contacts. This analysis revealed that the intervention exerted positive impacts on smoking reduction/cessation, social networks, coping, and health behaviors. Participants reported satisfaction with the intervention.

Introduction

Across the world, an estimated 236 million smokers are women; this number is predicted to triple by 2025 (Centre for Chronic Disease Prevention and Health Promotion [CCDPHP], 2001). Greater rates of smoking and lower levels of cessation have been observed in disadvantaged populations (CIHI, 2008, Jun and Acevedo-Garcia, 2007, Lillard et al., 2007). The complex connections between women’s smoking and disadvantage are linked to the preponderance of women living in poverty (Jun & Avecedo-Garcia, 2007; Spitzer, 2005; World Health Organization [WHO], 2002). Smoking-related problems experienced by women include: reduced productivity, quality of life, and life expectancy; and increased morbidity (Centers for Disease Control and Prevention, 2002, World Health Organization, 2002). Low-income women who smoke experience unique challenges with cessation (CCDPHP, 2001) and tobacco policies (Greaves, Vallone, & Velicer, 2006).

In Canada, there has been a gradual decline in women’s smoking rates (Public Health Agency of Canada, 2007). However, high smoking rates persist among low-income women (Ockene et al., 2002, van der Woerd et al., 2005).

Supportive interventions are needed to offset the negative impact of smoking on vulnerable women’s lives and their contributions to society. Cessation programs have yielded mixed results (Glasgow, Whitlock, Eakin, & Lichenstein, 2000), possibly because they are rarely tailored to the support needs and preferences of people facing health inequities (Lancaster & Stead, 2002). Researchers have often overlooked gender differences in the effectiveness of tobacco intervention programs despite evidence of gender-related reasons for smoking behavior (CCDPHP, 2001) and cessation ability (Borrelli, Spring, Niaura, Hitsman, & Papandonatos, 2001). Accordingly, the objective of this pilot study was to implement and evaluate the impact of a comprehensive support intervention that reflects the specific support needs of low-income women who smoke, the social factors (e.g., gender, income) influencing their smoking behavior, and their intervention preferences.

Section snippets

Relevant research

No rigorous tobacco cessation interventions have emphasized both gender and socioeconomic status and focused specifically on women living on low-incomes. Two studies involving post-hoc evaluations of programs geared to low-income populations focused on absolute cessation of smoking (Solomon et al., 2000, Wadland et al., 2001). For example, Solomon et al. tested the impact of free nicotine patches supplemented with peer support from a female ex-smoker via the telephone for up to three months. No

Research design

This pilot study involved implementing and evaluating a support intervention designed for low-income women who smoke which encompassed: (a) peer intervention agents in dyads and/or groups, and professional(s) on call as consultants or co-facilitators; (b) information, affirmation and emotional support offered primarily by peer intervention agents; (c) empowering strategies to enhance self-efficacy, coping, and positive health behaviors; (d) comprehensive focus on the social and economic context

Findings

There were no significant differences among the three groups of women (pre-test; pre-test and post-test; pre-test, post-test, delayed post-test) on any of the demographic variables. Quantitative data yielded information on intervention impacts on tobacco use, satisfaction with social support, social networks, self-efficacy, coping strategies (e.g., support seeking), and health behaviors (see Table 3). (Detailed statistical output available on request.) Qualitative data supplemented quantitative

Discussion

Quantitative data revealed significant decreases in temptation to smoke and number of cigarettes smoked, and significant increases in instrumental support seeking, eating breakfast, and breathing exercises. Moreover, non-significant trends in increased social network size and decreased loneliness are promising. Qualitative findings reinforce and supplement these results. The use of mixed methods in this study is a significant departure from previous studies that have used either quantitative

Acknowledgements

The research was funded by grants from the Social Sciences and Humanities Research Council, Alberta Heritage Foundation for Medical Research, and Alberta Alcohol and Drug Abuse Commission.

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Understanding the multitude of barriers that prevent smokers in lower socioeconomic groups from accessing smoking cessation support: A literature review
2019, Preventive Medicine
Citation Excerpt :
Three studies only included smokers from the general population (McDonald, 1999; Bains et al., 1998; Vidrine et al., 2013) and one study only included professionals (Vogt et al., 2005). The studies were performed in the United Kingdom (n = 17) (Hiscock et al., 2012; Murray et al., 2009; Thompson et al., 2015; Venn et al., 2016; Bauld et al., 2012; Owens and Springett, 2006; Henderson et al., 2011; Stead et al., 2001; Roddy et al., 2006; Bains et al., 2011; Wiltshire et al., 2003; Marcano Belisario et al., 2012; Bauld et al., 2010; Hiscock et al., 2013; Kotz and West, 2009; Bauld et al., 2009; Vogt et al., 2005), United States (n = 8) (King et al., 1997; Christiansen et al., 2015; Carlini et al., 2012; Woodruff et al., 2002; Christiansen et al., 2012; Matthews et al., 2009; Browning et al., 2008; Vidrine et al., 2013), Australia (n = 7) (Twyman et al., 2014; Ford et al., 2013; Pateman et al., 2015; Courtney et al., 2014; Siahpush et al., 2006a; Siahpush et al., 2006b; Bryant et al., 2010), the Netherlands (n = 5) (Benson et al., 2015; Nierkens et al., 2005; Benson et al., 2016; Benson et al., 2014; Benson, 2016), Canada (n = 4) (Stewart et al., 2011; Stewart et al., 2010; McDonald, 1999; Bains et al., 1998), Denmark (n = 1) (Pisinger et al., 2011), and Switzerland (n = 1) (Schnoz et al., 2010). The study designs were reviews (n = 10) (Twyman et al., 2014; Hiscock et al., 2012; Ford et al., 2013; Murray et al., 2009; King et al., 1997; Marcano Belisario et al., 2012; Bauld et al., 2010; McDonald, 1999; Bains et al., 1998; Vogt et al., 2005), randomized controlled trials (n = 4) (Christiansen et al., 2015; Carlini et al., 2012; Woodruff et al., 2002; Vidrine et al., 2013), surveys (n = 14) (Benson et al., 2015; Nierkens et al., 2005; Thompson et al., 2015; Venn et al., 2016; Benson et al., 2016; Bauld et al., 2012; Owens and Springett, 2006; Christiansen et al., 2012; Browning et al., 2008; Hiscock et al., 2013; Kotz and West, 2009; Siahpush et al., 2006a; Siahpush et al., 2006b; Pisinger et al., 2011), qualitative studies (n = 10) (Henderson et al., 2011; Benson et al., 2014; Stead et al., 2001; Stewart et al., 2011; Pateman et al., 2015; Roddy et al., 2006; Bains et al., 2011; Wiltshire et al., 2003; Bryant et al., 2010; Bauld et al., 2009), and other (n = 5) (Benson, 2016; Courtney et al., 2014; Stewart et al., 2010; Matthews et al., 2009; Schnoz et al., 2010).
One explanation for the increasing smoking-related health inequalities is the limited access of lower socioeconomic status (SES) smokers to smoking cessation support. In order to understand this limited access – and to eventually improve accessibility – we provide a structured overview of the barriers that lower SES smokers face in the successive phases of access to cessation support. Our literature review included 43 papers on barriers of access to cessation support for lower SES smokers, published before June 2016. We used the access to health care framework to categorize the extracted barriers into (a) either the abilities of smokers or dimensions of cessation support and (b) one of the successive phases of access to support. We found that lower SES smokers encounter many barriers. They are present in all phases of access to cessation support, and different barriers may be important in each of these phases. We also found that each phase transition is hampered by barriers related to both the abilities of smokers and the dimensions of cessation support, and that these barriers tend to interact, both with each other and with the disadvantaged living conditions of lower SES smokers. In conclusion, reducing smoking-related health inequalities by improving lower SES smokers' access to smoking cessation support requires a comprehensive approach. Our structured overview of barriers may serve as a starting point for tailoring such an approach to the multitude of barriers that prevent lower SES smokers from accessing cessation support, while simultaneously taking into account their disadvantaged living conditions.
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To collect formative information to design a tailored tobacco treatment intervention for women with newborns treated or evaluated for neonatal abstinence syndrome and to explore current tobacco use behaviors and facilitators and barriers to smoking cessation.
Qualitative descriptive study.
An academic medical center in the southern United States.
Mothers (N = 11) of newborns who were treated or evaluated for neonatal abstinence syndrome at birth within the preceding 3 months. Women recruited were older than 18 years and reported opioid dependence and smoking during pregnancy.
Participants took part in semistructured individual interviews that lasted approximately 1 hour. Interviews were professionally transcribed and analyzed in MAXQDA using content analysis.
Five themes emerged from the data: Strategizing to Reduce Risk, Desire to Quit Smoking in the Future, Holding on to Smoking While Working Through Recovery, Feeling Judged by Nurses, and Feeling Supported and Empowered by Nurses. Participants reported that they to reduce risk to their newborns by avoiding second- and thirdhand smoke exposure. Participants wanted to stop smoking but reported many barriers, including multiple life stressors compounded by their newborns' extended stays in the hospital. However, most participants described overall positive experiences and the support of health care providers.
Holistic tobacco treatment programs that incorporate stress relief and social support and are led by trusted health care providers have the potential to be effective to reduce smoking in new mothers with histories of opioid dependence disorders and smoking and whose newborns are in the NICU.
Connecting low-income smokers to tobacco treatment services
2016, Addictive Behaviors
Citation Excerpt :
Another potential limitation of the study was that the sample was disproportionately female as a result of the overarching programmatic goals of the NBCCEDP. Even though it is important to target low-income female smokers because their smoking rates are persistently high (Stewart et al., 2010), the current results could change if the program were implemented within an all-male sample or a sample with a more equal distribution of males and females. Disadvantaged populations have limited access to, and tend to underutilize, quality health care and preventive services (Kassler et al., 2015; Adler & Newman, 2002).
The Affordable Care Act calls for using population-level incentive-based interventions, and cigarette smoking is one of the most significant health behaviors driving costs and adverse health in low-income populations. Telehealth offers an opportunity to facilitate delivery of evidence-based smoking cessation services as well as incentive-based interventions to low-income populations. However, research is needed on effective strategies for linking smokers to services, how to couple financial incentives with telehealth, and on how to scale this to population-level practice. The current paper evaluates primary implementation and follow-up results of two strategies for connecting low-income, predominantly female smokers to a telephone tobacco quitline (QL). The population-based program consisted of participant-initiated phone contact and two recruitment strategies: (1) direct mail (DM) and (2) opportunistic telephone referrals with connection (ORC). Both strategies offered financial incentives for being connected to the QL, and all QL connections were made by trained patient navigators through a central call center. QL connections occurred for 97% of DM callers (N = 870) and 33% of ORC callers (N = 4550). Self-reported continuous smoking abstinence (i.e., 30 smoke-free days at seven-month follow-up) was 20% for the DM group and 16% for ORC. These differences between intervention groups remained in ordered logistic regressions adjusting for smoking history and demographic characteristics. Each recruitment strategy had distinct advantages; both successfully connected low-income smokers to cessation services and encouraged quit attempts and continuous smoking abstinence. Future research and population-based programs can utilize financial incentives and both recruitment strategies, building on their relative strengths.
Social predictors of cessation treatment use among smokers with serious mental illness
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Social factors play an important role in quitting smoking in the general population, but relatively little is known about social influences on smoking cessation efforts among individuals with serious mental illness who suffer disproportionately high rates of smoking. This study examined social factors as predictors of using smoking cessation treatment among adults with serious mental illness.
We conducted a secondary analysis of data from a randomized study comparing two versions of a motivational decision support system for smoking cessation treatment including 124 smokers with schizophrenia or severe mood disorders. Hierarchical logistic regression with blocked entry of theoretically linked predictor variables was used to model two types of social influences (explicit and implicit) as predictors of using cessation group therapy or smoking cessation medication.
Approximately 31% of participants initiated smoking cessation treatment during the 2-month follow-up. Hierarchical logistic regression analyses revealed that over and above demographic and personal factors, implicit social influences (others' approval of treatment) significantly predicted use of smoking cessation medication, while explicit social influences (smoking with others) significantly predicted use of cessation group therapy.
For people with serious mental illness, social factors appear to influence use of smoking cessation treatment above and beyond personal factors and may be specific to the type of treatment. These data support the need to further explore the role of social factors as potential leverage points for engagement in smoking cessation treatments in this population.
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This approach is supported by another study that looked specifically at the impact of social support for smoking cessation among low-income Canadian women. The study showed that a participatory approach increases womens' trust in the strength of the intervention (Stewart et al., 2010). It also emphasized that social support involved in having a peer/mentor to deliver practical educational material increased the chances of smoking cessation during pregnancy.
previous research has suggested that pregnant women prefer a person-centred approach for smoking cessation interventions. However few studies have illustrated the mechanism through which such an approach has an influence on quitting or reduction rates among pregnant women in resource poor settings.
to explore the role of different components included in a smoking cessation intervention delivered to disadvantaged pregnant women with high smoking rates attending public health antenatal clinics in South Africa.
a qualitative design consisting of focus-group discussion with women exposed to the intervention was used. Women were purposively selected from four antenatal clinics and one tertiary hospital to represent different experiences of the intervention. Focus group discussions with four groups of smokers and four groups of quitters were conducted and a total of 41 women were interviewed. Data were analysed using content analysis.
the main theme describing the intervention effect that emerged from the interviews was, ‘Making identification with change possible’. The categories ‘An impulse for change’, ‘An achievable recipe’, ‘A physical reminder’ and ‘A compassionate companion’ further described how each intervention component was perceived by women and how it contributed to behaviour change.
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View full text

Impacts of a support intervention for low-income women who smoke

Abstract

Introduction

Section snippets

Relevant research

Research design

Findings

Discussion

Acknowledgements

Social Science & Medicine

Social Science & Medicine

American Journal of Preventive Medicine

Preventive Medicine

Social Science & Medicine

Social Science & Medicine

Addictive Bahaviors

The effect of a multi-component smoking cessation intervention in African American women residing in public housing

Research in Nursing & Health

Reducing health disparities through community based research

Public Health Reports

Self-efficacy beliefs as shapers of children’s aspirations and career trajectories

Child Development

Self-help groups at the turning point. Emerging egalitarian alliances with the formal care system

American Journal of Community Psychology

Influences of gender and weight gain on short-term relapse to smoking in a cessation trial

Journal of Consulting and Clinical Psychology

Age, gender and family: Urban poverty in Canada, 2000

Reducing gaps in health: A focus on socio-economic status in urban health

Women and smoking: a report of the surgeon general executive summary

Women and smoking: a report of the surgeon general –2001

Research design: Qualitative, quantitative and mixed methods approaches

An exploration of the problems faced by young women living in disadvantaged circumstances if they want to give up smoking: can more be done at general practice level?

Family Practice

A smoking cessation intervention in a paediatric clinic setting reduced smoking in low-income women

Archives of Pediatrics and Adolescent Medicine

Relapse prevention for smoking cessation: review and evaluation of concepts and interventions

Annual Review of Public Health

Increasing response rates to postal questionnaires: systematic review

British Medical Journal

Measuring nicotine dependence: fagerstrom tolerance questionnaire

Journal of Behavioural Medicine

Women, low income and smoking: developing community-based initiatives

Health Education Journal

External validity: we need to do more

Annals of Behavioural Medicine

A brief smoking cessation intervention for women in low-income planned parenthood clinics

American Journal of Public Health

Accomplishments and challenges of social support intervention research

Pathways of disadvantage and smoking careers: evidence and policy implications

Journal of Epidemiology and Community Health

Special effects: tobacco policies and low socioeconomic status girls and women

Journal of Epidemiology and Community Health

The proactive coping inventory: A multidimensional research instrument

A partnership approach to health promotion: a case study from Ireland

Health Promotion International