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Nicotine & Tobacco Research Advance Access published online on October 29, 2009
Nicotine & Tobacco Research, doi:10.1093/ntr/ntp158
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© The Author 2009. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Employment, gender, and smoking cessation outcomes in low-income smokers using nicotine replacement therapy

Diana J. Burgess, Steven S. Fu, Siamak Noorbaloochi, Barbara A. Clothier, Jennifer Ricards, Rachel Widome and Michelle van Ryn

Diana J. Burgess, Ph.D., Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN, and Department of Medicine, University of Minnesota, Minneapolis
Steven S. Fu, M.D., M.S.C.E., Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN, and Department of Medicine, University of Minnesota, Minneapolis
Siamak Noorbaloochi, Ph.D., Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN, and Department of Medicine, University of Minnesota, Minneapolis
Barbara A. Clothier, M.S., Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN
Jennifer Ricards, B.A., Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN, and Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
Rachel Widome, Ph.D., Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN, and Department of Medicine, University of Minnesota, Minneapolis
Michelle van Ryn, Ph.D., M.P.H., Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, and Department of Family Medicine and Community Health, University of Minnesota, Minneapolis

Corresponding Author: Diana J. Burgess, Ph.D., Center for Chronic Disease Outcomes Research, VA Medical Center, One Veterans Drive 152/2E, Minneapolis, MN 55417, USA. Telephone: 612-467-1591; Fax: 612-727-5699; E-mail: diana.burgess{at}va.gov


  Abstract

Introduction: This study examines the presence and correlates of gender disparities in smoking cessation among lower income smokers prescribed nicotine replacement medication.

Methods: We examined quit rates (7-day abstinence point prevalence) among a cohort of smokers who filled prescriptions for nicotine replacement (N = 1,782), using Minnesota Health Care Programs’ (e.g., Medicaid) pharmacy claims databases (2005–2006) and mixed-mode survey protocols. A cohort of smokers who recently filled a prescription for nicotine replacement was stratified by race, and then subjects were selected by simple random sample from each race, oversampling the nonWhite groups (N = 1,782). The primary outcome was point prevalence of 7-day abstinence, and outcomes were assessed about 8 months after the nicotine replacement therapy (NRT) index prescription fill date using a mixed-mode survey protocol. Final interaction models were constructed using backward elimination.

Results: Abstinence rates were 11.4% among women and 19.2% among men (p = .02) and remained marginally significant after controlling for demographics, mental and physical health, period of cigarette abstinence, social environment, religious attendance, perceived stress, and NRT prescription type (p = .08). There was a significant Gender x Employment interaction (p = .02). Among men, quit rates were higher among the employed (26%) compared with the unemployed (16%); among women, quit rates were lower among those who were employed (8%) compared with those who were unemployed (14%).

Discussion: Results suggest the need for research on factors specific to women's work roles or workplaces that inhibit cessation as well as cessation programs tailored to low-income, employed female smokers. On-site workplace interventions and flexible counseling programs may be especially beneficial.

Received: April 7, 2009; Accepted: September 14, 2009
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