Designing a proactive smoking cessation treatment program: Focus group findings from low-income users

Tobacco use rates are significantly higher among low-income populations compared to the general population. Low-income smokers are less likely to use evidence-based smoking cessation treatments to help quit. Data suggest that proactive outreach, including systematically contacting everyone in a population of known smokers can increase the use of treatment programs. For proactive outreach programs to be successful, materials and interventions must be targeted to the population of interest. To target our materials to a low-income population receiving state-subsidized health care insurance, we conducted eight focus groups with low-income smokers residing in a major metropolitan area. Focus group participants (N= 59) reacted to outreach letters, brochures and the design of the program in a semi-structured conversation led by a professional moderator. Program design elements included outreach mailings and phone calls, phone counseling and free nicotine replacement products. Results indicate that participants were enthusiastic about a personalized, nonjudgmental, “innovative” program which gave them permission about ambivalence towards quitting and which included language and images representative of low-income smokers. Participants also expressed mistrust of outsiders and were concerned about potential intrusiveness by the phone coaches. Participants were positive about receiving outreach materials from a trusted organization such as the University (the program sponsor) and responded positively to free counseling and free NRT. Overall, results indicate that proactive smoking cessation programs targeting low-income smokers should provide free, nonjudgmental and flexible services; a participant-driven call schedule; the backing of a trusted organization in the community; and images and language representative of the community.