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Drug Alcohol Depend. 2017 Dec 1;181:177-185. doi: 10.1016/j.drugalcdep.2017.09.015. Epub 2017 Oct 12.

Improving tobacco dependence treatment outcomes for smokers of lower socioeconomic status: A randomized clinical trial.

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City University of New York School of Medicine, City College of New York, 160 Convent Ave, New York, NY 10031, United States. Electronic address:
Advanced Recovery Research Center, Virginia Tech Carilion Research Institute, 2 Riverside Circle, Roanoke, VA 24016, United States.
Department of Statistics, Virginia Tech, Blacksburg, VA 24061, United States.
City University of New York School of Medicine, City College of New York, 160 Convent Ave, New York, NY 10031, United States.



Evidence-based treatments for tobacco dependence are significantly less effective for smokers of lower socioeconomic status which contributes to socioeconomic disparities in smoking prevalence rates and health. We aimed to reduce the socioeconomic gradient in treatment outcomes by systematically adapting evidence-based, cognitive-behavioral treatment for tobacco dependence for diverse lower socioeconomic smokers.


Participants were randomized to adapted or standard treatment, received six 1-h group treatment sessions, and were followed for six months. We examined the effectiveness of the adapted treatment to improve treatment outcomes for lower socioeconomic groups.


Participants (n=227) were ethnically, racially, and socioeconomically diverse. The adapted treatment significantly reduced the days to relapse for the two lowest socioeconomic groups: SES1: M=76.6 (SD 72.9) vs. 38.3 (SD 60.1) days to relapse (RR=0.63 95% CI, 0.45, 0.88, p=0.0013); SES2: M=88.2 (SD 67.3) vs. 40.1 (SD 62.6 days to relapse (RR=0.57 95% CI, 0.18, 0.70, p=0.0024). Interactions between socioeconomic status and condition were significant for initial abstinence (OR=1.26, 95% CI 1.09, 1.46, p=0.002), approached significance for 3-month abstinence (OR=0.90, 95% CI 0.80, 1.01, p<0.071), and were not significant for 6-month abstinence (OR=0.99 95% CI 0.88, 1.10, p=0.795). No significant differences in long-term abstinence were observed.


Systematic adaption of evidence-based treatment for tobacco dependence can significantly improve initial and short-term treatment outcomes for diverse lower socioeconomic smokers and reduce inequities in days to relapse. Novel methods of providing targeted extended support are needed to improve long-term outcomes.


Black or african american; Disparities; Lower socioeconomic status; Relapse; Smoking cessation; Treatment for tobacco dependence

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