Treatment for tobacco dependence for rural, lower-income smokers: Outcomes, predictors, and measurement considerations

Purpose. Outcomes from a statewide program that delivered evidence-based, intensive treatment for tobacco dependence to a rural population of lower socioeconomic status (SES) were evaluated. Factors that predicted success and measurement considerations were examined. Design and Analyses. Data were collected at intake, at all treatment sessions, and at 3- and 12-months posttreatment. Abstinence rates were calculated using complete-case analysis and intention-to-treat analysis, and they were estimated for all participants. Logistic regression was used to evaluate the predictive significance of demographic and clinical factors. Setting. Twenty health care sites across Arkansas. Participants. A total of 2,350 predominantly rural, lower SES, Arkansas residents. Intervention. Evidence-based, six-session, multi-component cognitive-behavioral therapy with relapse prevention. Results. The estimated percent abstinent was 26.47% at 3-months and 21.73% at 12-months posttreatment; 51.02% of patients completed treatment and demonstrated markedly higher quit rates. Although numerous factors predicted outcomes at different points, self-efficacy and dependence levels at intake were robust predictors across time and methods of calculating outcomes. Sex, partner smoking status, and educational level were significant predictors of long-term abstinence. Conclusions. This study demonstrates that intensive, evidence-based treatment for tobacco dependence can be successfully delivered in a statewide program and can yield long-term outcomes that approximate those seen in more controlled settings. Overall sample estimates may be more appropriate for the assessment of outcomes in this context. (Am J Health Promot 2009;23[5]: 328-338.)