Why the study?
Do additive interventions including financial incentives improve sustained tobacco abstinence in medically underserved patients referred for lung cancer screening?
RCT (n=3,259)
Yes
Do additive interventions including financial incentives improve sustained tobacco abstinence in medically underserved patients referred for lung cancer screening?
Effect estimate: 4.6 percentage point difference (95% CI 2.1-7.0)
Absolute Event Rate: 8.8% vs 4.3%
p-value: p=< 0.001
Financial incentives significantly improve sustained tobacco abstinence rates among medically underserved patients undergoing lung cancer screening compared to standard referral or free pharmacotherapy alone.
Financial incentives merit consideration in lung cancer screening referrals; extends RCT evidence for cessation in underserved populations.
Background Health systems must offer smoking cessation services to maximize benefits and be reimbursed for lung cancer screening, but the most effective tobacco treatment interventions for medically underserved patients undergoing screening are unknown. Methods We conducted a pragmatic comparative effectiveness clinical trial among patients referred for lung cancer screening who identified as Black, Hispanic or Latine, rural, and/or having low socioeconomic status based on household income and formal education level. The trial was conducted at five geographically varied health systems. We compared four additive interventions: ask-advise-refer (to smoking cessation services); plus free pharmacotherapy (i.e., nicotine replacement and reimbursement for varenicline or bupropion); plus financial incentives up to $600 contingent on cessation; plus a text-based episodic future thinking tool (FutureMe). The primary endpoint was biochemically confirmed, sustained tobacco abstinence through six months. Results From May 17, 2021 to January 31, 2024, 3,259 patients were randomized and 3,220 (98.8%) were analyzed. The majority (55.5%) reported smoking >10 cigarettes per day at enrollment; 25.5% were Black, 8.9% Hispanic/Latine, 38.8% rural, and 74.9% had low socioeconomic status. The rate of sustained tobacco abstinence through six months was 4.3% with ask-advise-refer, 5.1% with pharmacotherapy added, 8.8% with financial incentives added, and 7.2% with episodic future thinking added (Figure). Financial incentives increased the rate of sustained tobacco abstinence compared to ask-advise-refer alone (4.6 percentage point difference, 95% CI 2.1-7.0, p < 0.001) or free pharmacotherapy (4.1 percentage point difference, 95% CI 1.7-6.4, p < 0.001). Free pharmacotherapy was not superior to ask-advise-refer alone (0.5 percentage point difference, 95% CI -1.7-2.6, p = 0.66). Conclusion Financial incentives were the most successful strategy for promoting sustained tobacco abstinence among medically underserved patients referred for lung cancer screening. This abstract is funded by: Patient Centered Outcomes Research Institute
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Hart et al. (2026) conducted an RCT in Tobacco use in patients referred for lung cancer screening (n=3,259). Financial incentives (additive to ask-advise-refer and pharmacotherapy) vs. Ask-advise-refer alone was evaluated on Biochemically confirmed, sustained tobacco abstinence through six months (4.6 percentage point difference, 95% CI 2.1-7.0, p=< 0.001).
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