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Tobacco Treatment for Employable Californians

Institution: Stanford University
Investigator(s): Judith Prochaska, Ph.D., M.P.H.
Award Cycle: 2015 (Cycle 24) Grant #: 24RT-0035H Award: $573,934
Subject Area: Disparities /Prevention/ Cessation/ Nicotine Dependence
Award Type: Research Project Awards

Initial Award Abstract

Smoking is more prevalent among those with less education, lower income, the uninsured, and some ethnic minority groups. Hence, the effect of tobacco use on employability and economic security is likely to disproportionately affect key subpopulations. Responsive to TRDRP’s Research Priorities, our study “Tobacco Treatment for Employable Californians” seeks to mitigate tobacco-related health and economic disparities in Californians of low socioeconomic status.

Currently, 1.36 million Californian adults are unemployed. Our 2012 analysis of statewide data indicated 21% of jobseekers were current smokers in California compared to 15% of the employed and 16% of the non-participating labor force (retired/students). Building upon the extant studies of smoking and unemployment, which are all cross-sectional, our Pilot CARA centers on a 12-month longitudinal observational study of smoking and nonsmoking jobseekers (N=252, 66% male, 62% ethnic minority, 69% non-college-degreed, 22% unhoused). At baseline, in a model controlling for gender, age, race/ethnicity, homelessness, county of residence, education, access to transportation, criminal history, and past drug/alcohol treatment, only current smoking status and age were significantly associated with chronicity of unemployment. Further, time to first cigarette in the morning, a measure of tobacco dependence, predicted greater time out of work. Unrelated to time out of work was desire and intent to quit smoking and belief in one’s ability to quit. Many of the job-seekers reported intent to quit smoking due to past negative interactions at work, economic insecurity from their tobacco addiction, and health concerns. To date, 73% have completed the 6-month follow-up with 45% of nonsmokers vs. 25% of smokers re-employed. To control for potential confounds, a randomized trial of the impact of treating smoking on future employability is needed.

Our Research Project builds upon our piloted methods and foundational partnership with One-Stop employment development agencies in the Bay Area. Tailored to the motivations and perceived barriers of job seekers, the IMPACT intervention is relevant to all smokers, regardless of intention to quit; is web-delivered and individually- and motivationally-tailored; and emphasizes strategies to increase professional appearance, build self-efficacy, and achieve freedom from smoking. We believe this is the first randomized controlled trial evaluation of an employment-centered tobacco cessation intervention.

With three supporting aims, we will:

  1. Expand IMPACT from Marin and San Francisco to include San Mateo County;
  2. Evaluate the efficacy of a web-based job seekers’ quit smoking intervention in a 2-group randomized trial with N=360 smokers. Specifically, we hypothesize that the web-based job seekers’ quit smoking intervention initiated in employment service agencies, will result in significantly greater biochemically-confirmed tobacco abstinence over 6-months follow-up (primary) and accelerated time to employment (secondary), relative to the control condition.
  3. Explore job seekers’ use of electronic nicotine delivery systems (ENDS, e.g., e-cigarettes) including exposure to marketing, reasons for use (e.g., cessation, substitution), use duration, and frequency.

The research will (a) build the evidence for treating tobacco as an economic disparity issue and priority for employment service agencies, (b) inform understanding of the causal relationship between smoking cessation and employability, and (c) examine ENDS use among a vulnerable group and in California’s work settings.