Literature Review: Smoking Cessation Among Disadvantaged Groups

This literature review examines smoking cessation strategies among disadvantaged populations, focusing on individuals with low socioeconomic status. The review analyzes various interventions, including nicotine replacement therapy (NRT), behavioral therapy, financial incentives, and Mindfulness Training for Smokers (MTS). It assesses the effectiveness of these techniques, highlighting that a combination of interventions is generally more successful than a single approach. The review notes that factors such as stress management, cultural norms, and skeptic beliefs about smoking influence cessation rates. It also investigates whether the wealthy and socioeconomically disadvantaged smokers have similar intentions to quit smoking, the level of adoption of smoking cessation programs by socioeconomically disadvantaged populations, and how the delivery of smoking cessation programs affects quit rates. The review concludes that engaging the target population and addressing inherent factors that increase smoking intentions are crucial for improving cessation rates among disadvantaged groups, with a combination of NRT and behavioral therapy showing particular promise.

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Smoking Cessation among Disadvantaged Populations
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Smoking Cessation among Disadvantaged Populations
1. The search strategy
Electronic databases were searched to get relevant literature for this review. Keywords
were joined using Boolean operators including “AND’, “OR” and “NOT” and used during the
search. The keywords are smoking, tobacco, cessation, quit, disadvantaged, socioeconomically
disadvantaged, and low socioeconomic status. These search terms were combined and altered to
yield many results. The search results were limited to English publications, last five years, and
search terms. Besides, the search was limited to peer-reviewed and scholarly articles. The search
results were hand reviewed for relevancy, duplication, and possible errors.
2. The reasons for including/excluding articles for the review and the pertinence and
quality of the papers included
The criterion of including and excluding papers in this review was based on various
fundamental factors. Only studies that focused on disadvantaged populations were included. In
this context, disadvantaged populations include people living in low socioeconomic status (SES),
unemployed individuals and those earning low incomes. All papers that did not define the target
population or focused on the broad populations were excluded from this review. In addition, the
review included studies that present both pharmacological and non-pharmacological smoking
cessation interventions. Importantly, some studies detailed pharmacological trails only while
others focused on non-pharmacological cessation interventions only. Papers, whereby the
therapy is administered by peers such as friends or family members and unqualified individuals,
are excluded. In essence, the papers that include nurses, medical professionals, nurses, cessation
counselors, and qualified social workers are included in the review.

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The selection criterion also considered the kinds of interventions detailed in the papers. In
this regard, the papers that were included focused on nicotine replacement therapy, behavioral
therapy, Mindfulness Training for Smokers, and financial incentives. The papers used different
population sizes in their trials in an effort to determine the effectiveness and effect of smoking
cessation attributes. The review excluded studies that focused on group therapies such as group
counseling. Evidently, the review wanted to determine the effectiveness or effect of individual
cessation therapies. Papers were excluded in case they were not original accounts of therapies
developed to support smoking quitting efforts, failed to include peer support components in the
interventions or failed to analyze the peer support components of the interventions. Eventually,
ten papers were selected as suitable for the review.
3. The evidence on the topic
In Australia, the prevalence of smoking is 23 per cent for individuals in the lowest
socioeconomic quintile and 10 per cent within the highest socioeconomic quintile (Twyman et
al., 2018, p.170). Recent research has found that the use of cessation aids as well as lower odds
of experiencing financial stress cause people to quit smoking (Twyman et al., 2018, p.170).
According to Guillaumier et al. (2016, p.118), a majority of socially disadvantaged smokers in
Australia have normalized the dangers associated with smoking. Besides, many of these smokers
have “skeptic” beliefs about smoking (Guillaumier et al., 2016, p.118). The barriers to smoking
cessation among disadvantaged populations include smoking to manage stress, inadequate
support from service providers and acceptance of smoking among the vulnerable communities
(Twyman et al., 2014, p.e006414). Indigenous populations are also likely to smoke because of
their historical and cultural norms (Twyman et al., 2014, p.e006414). As a result, the literature

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details the effectiveness of various smoking cessation techniques designed for disadvantaged
populations.
The effectiveness of nicotine replacement therapy (NRT) in Australia has been studied
comprehensively. The government-subsidised NRT for disadvantaged populations mainly
indigenous Australians is relatively ineffective (Paul et al., 2015, p.786). In fact, the evidence of
effectiveness for NTR is weak. One randomised study involving a sample population of 431
disadvantaged smokers in Australia found that free NRT is ineffective in achieving tobacco
abstinence (Bonevski et al., 2018, p.38). However, the intervention increased intentions and
attempts to quit smoking and even resulted in a decrease in the number of cigarettes smoked in a
day.
The combination of NRT with other non-pharmacological smoking cessation techniques
is effective for low socioeconomic status (SES). Courtney et al. (2014, p.1602) assert that the
integration of NTR with financial education is an ideal intervention for low SES Australian
smokers. Similarly, Fu et al. (2016, p.446) designed a study to determine the effectiveness of free
NRT and telephone counseling for disadvantaged populations. Based on the findings, the use of
population-based therapy increases engagement rates and is practical for long-term tobacco
cessation among low SES smokers (Fu et al., 2016, p.446).
Behavioral interventions have also been designed to enhance smoking cessation among
disadvantaged groups. Hiscock et al. (2013, p.2787) explored the effectiveness of behavioral
therapy for tobacco cessation among socioeconomically disadvantaged and wealthy smokers
using records of 202,084 individuals. The authors found that affluent smokers are more likely to
quit smoking if exposed to behavioral therapy than socioeconomically disadvantaged smokers
(Hiscock et al., 2013, p.2787). These findings suggest that socioeconomically disadvantaged

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smokers are not motivated to quit even after attending smoking cessation programmes. Kendzor
et al. (2015, p.1198) did a randomised study involving 146 disadvantaged smokers to determine
the effectiveness of financial incentives for smoking quitting. Based on the findings, financial
incentive tends to increase smoking abstinence rates among economically disadvantaged
populations (Kendzor et al., 2015, p.1198). Further, Mindfulness Training for Smokers (MTS)
has been found to be successful in enhancing tobacco quitting among disadvantaged groups
(Davis et al., 2014, p.571). In essence, different smoking cessation therapies have been designed
for disadvantaged populations.
4. Conclusions from the evidence
Less affluent populations are more likely to smoke than wealthy individuals because of
various factors such as smoking to manage stress and acceptance of smoking behaviors. In this
case, indigenous populations have higher chances of being smokers than the non-indigenous
populations. The evidence shows that a single intervention is less likely to improve smoking
cessation rates among disadvantaged populations. Ideally, a combination of interventions has a
high possibility of increasing cessation rates. Smoking cessation therapies should address
inherent factors that increase smoking intentions within the target population. A practical
cessation program should focus on skeptic beliefs that sustain smoking intentions.
The evidence further implies that free smoking cessation programs might be less effective
because the population is not motivated to attend the sessions or seek quit services. In this case,
subsidised cessation programs might be more effective for disadvantaged groups. An important
question is whether a combination of pharmacological and non-pharmacological interventions is
effective in improving cessation rates. The evidence suggests that interventions that engage the
population are more likely to yield positive results than cessation programs that do not engage

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the target population. Conclusively, a combination of NTR and behavioral therapy has a high
possibility of increasing cessation rates among disadvantaged populations.
5. The study objectives arising from the evidence
The primary objective is to establish whether the wealthy and socioeconomically
disadvantaged smokers have similar intentions to quit smoking. This objective has been
proposed because certain cessation techniques are more effective for the affluent smokers than
disadvantaged populations. Another objective is to determine whether socioeconomically
disadvantaged populations adopt smoking cessation programs and their level of engagement
during such programs. Importantly, the level of adoption of such programs as well as the level of
engagement tends to predict cessation rates. In this regard, a high adoption level and engagement
might increase quit rates among disadvantaged smokers.
The other objective arising from the evidence is to investigate how the delivery of
smoking cessation programs affects quit rates. This objective is inspired by the fact that there are
different methods of delivery such as telephone, one-on-one, and online therapies. In addition,
the professional or provider administering the therapy may influence its success level. Therefore,
it is important to determine whether the skills or competency of the professional influence the
effectiveness of the cessation interventions. The focus, in this case, will be the nurses, counselors
and other social workers who are involved in cessation programs. In essence, these objectives
will provide comprehensive information on smoking cessation among disadvantaged
populations.

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Bibliography
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Palazzi, K. (2018). Smoking cessation intervention delivered by social service organisations for a
diverse population of Australian disadvantaged smokers: A pragmatic randomised controlled
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Courtney, R.J., Bradford, D., Martire, K.A., Bonevski, B., Borland, R., Doran, C., Hall, W.,
Farrell, M., Siahpush, M., Sanson‐Fisher, R. and West, R. (2014). A randomized clinical trial of
a financial education intervention with nicotine replacement therapy (NRT) for low socio‐
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Davis, J.M., Goldberg, S.B., Anderson, M.C., Manley, A.R., Smith, S.S. and Baker, T.B. (2014.
Randomized trial on mindfulness training for smokers targeted to a disadvantaged population.
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Fu, S.S., Van Ryn, M., Nelson, D., Burgess, D.J., Thomas, J.L., Saul, J., Clothier, B., Nyman,
J.A., Hammett, P. and Joseph, A.M. (2016). Proactive tobacco treatment offering free nicotine
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Guillaumier, A., Bonevski, B., Paul, C., D’Este, C., Twyman, L., Palazzi, K. and Oldmeadow, C.
(2016). Self-exempting beliefs and intention to quit smoking within a socially disadvantaged
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Hiscock, R., Murray, S., Brose, L.S., McEwen, A., Bee, J.L., Dobbie, F. and Bauld, L. (2013).
Behavioural therapy for smoking cessation: the effectiveness of different intervention types for
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