Reducing tobacco smoking among low-SES smokers: A RCT to improve adherence with treatment, smoking cessation and health economic outcomes

image - Smoking Square
Date Commenced:
07/2015
Expected Date of Completion:
06/2017
Project Supporters:

Cancer Institute NSW

Drug Type:
Project Members: 
image - Ryan Courtney
Senior Lecturer
Ph 02 8936 1004
image - VB NDARC 2016 Photo 1
Postdoctoral Fellow
Ph 02 9385 0333
image - Richard Mattick
Honorary Visiting Professor
Ph 02 9385 0333
image - Michael Farrell 0
Director
Ph EA Tori Barnes: 02 9385 0292 / t.barnes@unsw.edu.au
Project Main Description: 

Smoking cessation rates need to improve among low-socioeconomic status (low-SES) Australians if we are to reach a key national target as the health country:  ≤ 9% smoking by 2020 .  Recent (2013) National Drug Strategy Household Survey data show that persons from disadvantaged areas are three times more likely to smoke daily compared to those from most advantaged areas (20% vs. 7%). Less change in smoking rates occurred for the most disadvantaged quintile between 2001 (26%) and 2013 (20%), than the large (close to three-fold) decrease for the most advantaged quintile over the same time period (19% and 7% respectively). These differences in smoking prevalence between the most and least advantaged Australians contributes to health inequalities.

Nicotine Replacement Therapy (NRT) can improve the likelihood of successful cessation but low-SES smokers comply poorly and discontinue NRT use earlier than high-SES smokers. 

Facilitating smoking cessation among low-SES smokers is a national priority. Yet, no evidence-based interventions to improve treatment compliance with NRT have been found.

This study will evaluate the cost-effectiveness of enhanced compliance instruction (via text message) as a strategy for increasing smoking cessation in low-SES smokers.

Project Collaborators: External: 

Professor Ron Borland
Cancer Council Victoria

Dr Coral Gartner
University of Queensland

Dr Hayden McRobbie
Queen Mary University London

Prof Mohammad Siahpush
University of Nebraska Medical Center

NSW Government/ Cancer Institute NSW

Quitlines

Department of Human Services

Rationale: 

Australian data indicates that Nicotine Replacement Therapy (NRT) compliance among low-SES smokers is poor, even though NRT is associated with a two-fold increase in successful cessation. A review in 2009 examining low-income groups and behaviour change interventions (including smoking) concluded that there was “a paucity of evidence about the effectiveness and cost-effectiveness of changing health behaviours in disadvantaged groups”. A further review in 2011 among disadvantaged population groups made a similar conclusion, identifying no evaluations of interventions to improve adherence to or consumption of NRT among low-SES smokers. Consequently, there are currently no evidence-based interventions for optimising NRT compliance, despite NRT compliance being a recognised modifiable factor that, if improved, would significantly decrease the disproportionally high smoking rates among low-SES populations.

Enhanced compliance with NRT and use of adequate doses of NRT is particularly important for low-SES smokers because:

  • Their level of nicotine dependence is generally higher than other smokers;
  • They have a greater degree of difficulty responding to health messages; and
  • They are more susceptible to myths and misperceptions about NRTs efficacy and safety, which undermines their NRT compliance, and their likelihood of cessation.
Aims: 

The aim of this study is to evaluate the cost-effectiveness of enhanced compliance instruction (via text messaging) to increase smoking cessation rates among low-SES smokers.

Design and Method: 

A methodologically rigorous (N = 408) single-blinded, two-group randomised controlled trial (RCT) will be conducted comparing continuous abstinence rates between (a) Control group: provision of NRT (nicotine patch + oral form of NRT) and standard NRT compliance instruction (usual care - consumer medicines information statement) versus (b) Intervention group: provision of the same NRT and enhanced NRT compliance instruction (text message support). 

Output: 

This research ultimately aims to advise policy-makers of an effective method to improve smoking cessation among low-SES populations, where disproportionally high smoking rates in New South Wales (NSW) and nationally persist. 

Benefits: 

The intervention is likely to be cost-effective because it is relatively inexpensive to deliver and targets a specific problem behaviour (low NRT compliance).

This research is innovative and if, effective, the text message NRT compliance intervention can be readily translated, up-scaled and delivered by Quitlines in NSW, nationally and internationally.

Drug Type: