Financial incentives combined with free smoking-cessation medication nearly doubled the six-month quit rate among medically underserved adults receiving lung cancer screening, according to a large randomized clinical trial reported by Henry Ford Health.
The trial, published in JAMA, enrolled more than 3,200 adults at five medical centers in the United States. It focused on people who face persistent barriers to high-quality health care, including people with lower incomes, rural residents, and Black and Hispanic adults.
Verified quit rates increased
Researchers compared four smoking-cessation strategies. At six months, 8.8% of participants who received free cessation medication and could earn up to $600 in financial incentives had quit smoking. The quit rate was 4.3% among people receiving usual care.
The study used blood or urine testing to verify abstinence, rather than relying only on participants’ reports. That verification is important in a clinical trial intended to measure whether an intervention leads to sustained smoking cessation.
The difference does not suggest quitting is easy. Participants had smoked for many years and may have attempted to quit before, according to Christine Neslund-Dudas, a Henry Ford Health researcher and study investigator. But the results indicate that financial incentives can be an additional tool for people who may need more support to stop smoking.
Screening creates a treatment opportunity
The research also highlights lung cancer screening as a point at which health systems can connect patients with tobacco-treatment services. People undergoing lung cancer screening have a smoking history that places them at increased risk of developing the disease.
At Henry Ford Health, tobacco treatment is integrated into its centralized lung cancer screening program. The approach connects people who smoke with cessation support as part of the screening process, rather than treating screening and smoking treatment as entirely separate services.
Mike Simoff, a Henry Ford Health pulmonologist and lung cancer screening expert, said lung cancer screening can help clinicians identify cancer earlier while also addressing smoking, an important risk factor for cancer and other diseases. The trial’s results provide evidence for pairing that clinical moment with practical cessation assistance.
Why the population matters
The study was conducted across Henry Ford Health, Penn Medicine, Lancaster General Health, Geisinger, and Kaiser Permanente Southern California. Its national scope and enrollment of more than 3,200 adults make it a substantial test of the approach in populations often underserved by the health-care system.
Smoking-cessation programs do not operate in a vacuum. Access to medication, time, transportation, financial pressure and prior experiences with health care can all shape whether a person is able to make and sustain a quit attempt. By providing medication at no cost and offering incentives, the intervention addressed some of the practical obstacles that can stand between an intention to quit and a successful outcome.
The reported outcome is also notable because it was measured after six months. Smoking cessation is difficult to maintain, and the study’s use of biological verification provides a defined benchmark for comparing the strategies tested.
An additional option for care teams
The trial does not mean that financial incentives alone will work for every person who smokes. It tested a specific combination of free cessation medication and the opportunity to earn up to $600, against usual care, within a lung cancer screening population.
Still, the results offer health systems a concrete approach to consider when designing cessation services for patients who face added barriers. The intervention produced a six-month verified quit rate that was roughly twice that of usual care in the study.
For clinicians and health systems, the broader implication is that cancer screening visits can serve two purposes. They can support earlier detection of lung cancer and create a structured opportunity to offer evidence-based help with quitting smoking. For patients, the study suggests that reducing cost barriers and recognizing the work involved in quitting may improve the odds of success.
Further implementation decisions will depend on how systems adapt cessation support to their patients and resources. But the national trial provides evidence that a medication-and-incentive program can improve verified quitting outcomes among adults for whom smoking cessation may be especially difficult to achieve.
This article is based on reporting by Medical Xpress. Read the original article.
Originally published on medicalxpress.com
