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Incentivizing Tobacco Helpline Engagement in Persistent Poverty Counties: A Randomized Trial.

Darla E Kendzor1, Morgan Davie2, Meng Chen3

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Financial incentives for completing smoking cessation coaching calls significantly increased abstinence rates in persistent poverty counties. This approach enhances treatment engagement and supports long-term smoking cessation efforts.

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Area of Science:

  • Public Health
  • Behavioral Science
  • Health Disparities

Background:

  • Persistent poverty counties (PPCs) exhibit high cancer mortality rates, partly due to elevated smoking prevalence.
  • Targeting smoking cessation in these underserved populations is crucial for reducing health disparities.

Purpose of the Study:

  • To evaluate the efficacy of financial incentives (FI) combined with the Oklahoma Tobacco Helpline (OTH) for smoking cessation in daily smokers from PPCs.
  • To determine if FI improve treatment engagement and abstinence rates compared to standard OTH treatment.

Main Methods:

  • A parallel 2-group randomized controlled trial was conducted with 165 daily smokers from PPCs calling the OTH.
  • Participants were randomized to receive standard OTH treatment (coaching calls + nicotine replacement therapy [NRT]) or OTH treatment plus financial incentives (OTH+FI) for completing coaching calls.
  • Outcomes included coaching call completion, incentive attainment, 7-day point abstinence at 8 and 12 weeks, and study retention.

Main Results:

  • Participants in the OTH+FI group showed significantly higher 7-day abstinence rates at 8 weeks (AOR=2.28) and 12 weeks (AOR=2.00) compared to the OTH group.
  • The OTH+FI group completed more coaching calls (aRR=1.53) and were more likely to complete at least 3 calls (AOR=3.64).
  • Coaching call completion mediated the effect of FI on smoking abstinence; study retention was high (>83%) and similar between groups.

Conclusions:

  • Offering small financial incentives for completing OTH coaching calls is a feasible and effective strategy to boost treatment engagement.
  • This intervention shows promise for increasing smoking cessation rates among individuals in persistent poverty counties.
  • Financial incentives represent a valuable tool for addressing smoking-related health disparities in vulnerable populations.