Pathways to Health: A Cluster Randomized Trial of Nicotine Gum and Motivational Interviewing for Smoking Cessation in Low-Income Housing

Abstract

Despite high smoking rates among those living in poverty, few cessation studies are conducted in these populations. This cluster-randomized trial tested nicotine gum plus motivational interviewing (MI) for smoking cessation in 20 low-income housing developments (HDs). Intervention participants (10 HDs, n = 66) received educational materials, 8 weeks of 4 mg nicotine gum, and 5 MI sessions on quitting smoking. Comparison participants (10 HDs, n = 107) received 5 MI sessions and educational materials addressing fruit and vegetable consumption. Participants had a mean age of 46.3 years and were predominantly female (70%) and African American (83%). Biochemically-verified 7-day abstinence rates at 8 weeks were 6.1% and 5.6% in the intervention and comparison arms, respectively (p = ns); and at 26 weeks were 7.6% and 9.3%, respectively (p = ns). Results suggest that nicotine gum plus MI were not effective for smoking cessation in low-income housing. Programs are needed to enhance the effectiveness of pharmacotherapy and counseling in underserved populations.

Tobacco Cessation Among Low-Income Smokers: Motivational Enhancement and Nicotine Patch Treatment

“…This finding of limited effectiveness of ME as a component of smoking interventions is consistent with a meta-analysis of clinical trials that used adaptations of MI and found low efficacy of the MI approach for smoking in the general population (Burke, Arkowitz, & Menchola, 2003). Additionally, our findings are consistent with the work of Okuyemi et al (2007), who also tested a motivational focused smoking cessation trial conducted in low-income housing developments (83% African American) and failed to find the addition of a MI component to NRT effective for smoking cessation (Okuyemi et al, 2007(Okuyemi et al, , 2013. Findings from the current study highlight the importance of several factors relating to tobacco cessation in a sample of low-SES smokers.…”

“…However, among pregnant smokers and young parents, there is no evidence for ME's effectiveness over other interventions (Lumley et al, 2009), and the empirical support for ME smoking cessation interventions with psychiatric populations (Baker et al, 2006), substance users (Haug, Svikis, & Diclemente, 2004;Stein et al, 2006), and general samples of primary care and hospital patients (Heckman et al, 2010) has not been established. To date, there are only a limited number of studies that have specifically focused on testing ME smoking cessation interventions for low-SES smokers (Okuyemi et al, 2007(Okuyemi et al, , 2013, and none that we were able to identify, which delivered ME treatment to low-income populations in primary health care centers.…”

Motivational Interviewing Improves Weight Loss in Women With Type 2 Diabetes

“…Resnicow and colleagues (40,41) have shown that the addition of motivational interviewing to a culturally tailored program designed to promote fruit and vegetable consumption increased intake among African-American subjects by approximately one serving per day above that with self-help materials alone. However, another study of African-American female smokers failed to find an effect for motivational interviewing (42). The current study is the first to report the potentially attenuated impact of motivational interviewing among African-American women relative to white women.…”

A Test of Motivational Plus Nicotine Replacement Interventions for HIV Positive Smokers

“…Currently, MI as a smoking cessation intervention shows mixed results. While MI shows some promise with adult dependent smokers in primary care (Soria et al 2006) and postpartum women (Thyrian et al 2007), it did not increase quitting among low-income housing residents (Okuyemi et al 2007), cancer patients offered NRT (Wakefield et al 2004), nor pregnant smokers receiving home-based midwife care (Tappin et al 2000). However, these studies (with the exception of Wakefield) used MI alone rather than paired with NRT.…”