fbpx Reducing tobacco smoking among low-SES smokers: A RCT to improve adherence with treatment, smoking cessation and health economic outcomes | NDARC - National Drug and Alcohol Research Centre

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:
Expected Date of Completion:
Project Supporters:

Cancer Institute NSW

Drug Type:
Project Members: 
image - Ryan Courtney
Heart Foundation Future Leader Fellow
Ph +61-2-90657655
image - Veronica Boland 0
Postdoctoral Research Fellow
Ph 02 9385 0333
image - Anthony Shakeshaft Square
Visiting Professorial Fellow
Ph 02 9385 0333
image - Michael Farrell 0
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


Department of Human Services


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.

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). 


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. 


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: