Helping the Poor Quit Smoking: Specialized Quitlines and Meeting Basic Needs

Project Summary/Abstract: The impact of COVID-19 on low-income and minority populations has been profound, spanning health,employment, income, food, rent, transportation and daily needs like diapers and toilet paper. In Missouri,where the parent study and proposed supplement take place, disparities abound. African Americans make up<12% of the state population but over 40% of COVID-19 deaths - the second largest gap in the U.S. amongstates reporting race data. As of April 20, 2020, we have enrolled 1,743 low-income daily smokers in the parentstudy, a randomized trial testing two cessation interventions. Over half report annual household income<$10,000, most (59%) are African American, and many (30%) did not complete high school. They are alsosick: 50% report at least one chronic condition (28% asthma, 20% COPD, 15% Type II diabetes, 10% heartdisease), and 56% rate their health as "fair" (39%) or "poor" (17%). From March 9 to April 16, 2020, weadministered COVID-19 survey items to 88 participants. Awareness of COVID-19 was high, but protectivebehaviors were inconsistent, and occupational exposures were high: of those who worked - 74% AfricanAmericans - only 19% had been off work and 6% worked from home during COVID. In short, low-wageminority smokers, often in fair or poor health, were working outside the home, having more contact with others,but with little protective equipment. We propose a highly innovative study in this sub-group using intensivelongitudinal data collection and cutting-edge time series analyses to understand complex, dynamicrelationships among four factors identified as priorities in the RFA: (1) employment disruptions; (2) social andeconomic needs; (3) adherence to COVID-19 containment and mitigation recommendations; and (4) healthindicators and behaviors. The study will produce estimates that can be used to model adherence to protectivemeasures and disruption to daily needs, personal health, and health behaviors such as smoking in low-wageminority workers during pandemics.