Association of individual and neighborhood socioeconomic status with outcomes of a smoking cessation intervention provided in the lung cancer screening setting

Background: Lung cancer screening (LCS) offers a teachable moment for smoking cessation. This study assesses whether individual- or neighborhood-level SES is associated with tobacco abstinence and completion of a smoking cessation intervention in the LCS context.

Methods: Secondary analysis of a clinical trial (NCT03611881) that tested the effectiveness of smoking cessation treatment for smokers scheduled for LCS (N = 615) in eastern Massachusetts, USA from 2019 to 2024. Outcomes were self-reported 7-day smoking abstinence and study follow-up completion at 6-months. Independent variables were individual SES (high school or less [low SES] vs. post-high school education [high SES]); neighborhood SES (Area Deprivation Index [ADI], range: 0-100, categorized as: highest 15 % [low SES] vs. remaining 85 % scores [high SES]), and a combination of both measures. Logistic regression models tested the association between outcomes and SES measures, adjusted for covariates.

Results: 32 % of participants had low individual SES. The mean sample ADI was 19.9 (SD: 12.8). Smoking cessation was higher among those with high vs. low neighborhood SES (15.7 % vs. 7.4 %, p-value = 0.03). Study completion was marginally higher among those with high vs. low individual SES (84.5 % vs. 78.1 %, p = 0.05). In multivariable models, these associations were not significant, but individuals with high individual and low neighborhood SES were more likely to complete the study than those with both low individual and low neighborhood SES, (OR: 6.04, 95 %CI: 1.47-24.7).

Conclusion: Individual and neighborhood SES were not independently associated with the study outcomes in the multivariable analysis, but combinations of individual and neighborhood SES differentially affected treatment completion.