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Outcomes of tobacco treatment in rural USA

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I’ve previously talked about the outcomes of our tobacco treatment services here in New Jersey and also in the UK. But New Jersey is the most densely populated state in this country, and so I was interested to see a paper that examined the outcomes of similar services for low-income smokers in rural Arkansas, USA.

The paper was published by Dr Christine Sheffer (College of Public Health, University of Arkansas). and colleagues, and examined the outcomes and predictors of outcome at 20 smoking cessation services at healthcare sites across Arkansas. 2,350 smokers attended for treatment, which mainly consisted of 6 smoking-cessation group meetings, with the option of pharmacotherapy also available. The estimated quit rates were 26% at 3 months follow-up and 22% at one year follow-up. Those with a higher confidence they could quit, lower dependence, a non-smoking partner and those with more education were more likely to succeed in quitting.

A few things struck me on reading this paper. The first is that the researchers in Arkansas have clearly shown that there is a demand for intensive face-to-face counseling, and that even in a relatively rural area, it can be done. The other thing that struck me was the similarity of results to the ones we had published a few years ago based upon a similar analysis of nicotine dependence treatment at our clinic in New Jersey. We also found that socioeconomic factors like unemployment or education, and measures of dependence (e.g. cigarette consumption.) all predicted poorer outcomes, much as they did in Arkansas.

One thing that was a bit different was that at these clinics in Arkansas only 42% of participants used a smoking cessation medication, whereas here in New Jersey typically around 90% of our patients choose to use a medicine. The lower medication use rates in Arkansas may reflect the socioeconomic circumstances of the clients, and may also partly explain the slightly lower quit rates in Arkansas.

But overall the similarities greatly outweigh the differences. These types of services are clearly feasible and achieve good quit rates. These results make me think that more face-to-face tobacco treatment should be made available across the country as in the U.K.

Id be interested to hear from anyone who has attended a smoking cessation service for help to quit. What treatment was provided and what seemed to help you?


References

Sheffer CE, Stitzer M, Payne TJ, Applegate BW, Bourne D, Wheeler JG. Treatment for tobacco dependence for rural, lower-income smokers: outcomes, predictors, andmeasurement considerations. Am J Health Promot. 2009 May-Jun;23(5):328-38.


Foulds J, Gandhi KK, Steinberg MB, Richardson DL, Williams JM, Burke MV,Rhoads GG. Factors associated with quitting smoking at a tobacco dependence treatment clinic. Am J Health Behav. 2006 Jul-Aug;30(4):400-12.
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About the Author


MA, MAppSci, PhD

Dr. Jonathan Foulds is an expert in the field of tobacco addiction.

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