Comparing Smoking Cessation Interventions among Underserved Patients Referred for Lung Cancer Screening: A Pragmatic...

Area of Science:

• Public Health
• Clinical Trials
• Health Disparities

Background:

• Smoking cessation interventions are crucial for lung cancer screening (LCS) programs, especially for underserved populations who bear the greatest smoking burden.
• Optimal cessation strategies for underserved patients within LCS settings remain understudied.
• This research addresses the need to identify effective interventions to reduce smoking-related mortality and disparities.

Purpose of the Study:

• To compare the effectiveness of four distinct interventions aimed at promoting smoking cessation among underserved patients referred for LCS.
• To identify which combination of pharmacologic aids, financial incentives, or digital tools, when added to standard care, most effectively increases smoking abstinence.

Main Methods:

• A pragmatic, randomized clinical trial involving 3,200 adults with LCS orders who smoke daily and belong to an underserved group.
• Four arms comparing standard 'ask-advise-refer' care with the addition of (1) cessation pharmacotherapy, (2) financial incentives up to $600, or (3) a mobile health tool for future thinking.
• Primary outcome: biochemically confirmed smoking abstinence at 6 months; secondary outcomes include 12-month abstinence and patient-reported outcomes.

Main Results:

• Hypothesizes that incremental additions of cessation aids, financial incentives, and digital tools will lead to higher smoking abstinence rates compared to standard care alone.
• Enrollment targets diverse, underserved populations including racial/ethnic minorities, rural residents, those with lower education, and low-income individuals.
• The study is registered on clinicaltrials.gov (NCT04798664) and launched in May 2021.

Conclusions:

• This trial will provide crucial evidence on the most effective smoking cessation strategies for implementation within LCS programs.
• Findings aim to reduce the disproportionate burden of smoking-related diseases in underserved communities.
• Identifying optimal interventions can improve health equity and reduce lung cancer mortality in high-risk populations.