- Design
- Four-arm randomised clinical trial at 4 US health systems
- Population
- 3,220 underserved adults who smoked and were referred for lung cancer screening
- Primary outcome
- Biochemically confirmed sustained abstinence through 6 months
- Effect
- 8.8% with incentives vs 4.3% usual care; difference 4.6 points (95% CI 2.1 to 7.0)
A randomised trial at four US health systems enrolled 3,220 people who smoked and were referred for lung cancer screening, all Black, Hispanic, rural or on low incomes. They were assigned to ask-advise-refer alone, or that plus free medication, plus financial incentives of up to $600 for biochemically confirmed quitting, or plus incentives and a mobile app.
Sustained abstinence at six months, confirmed by cotinine, anabasine or carbon monoxide testing, was 4.3% with ask-advise-refer, 5.1% with free medication, 8.8% with incentives and 7.2% with incentives plus the app. Incentives beat usual care by 4.6 percentage points (95% CI 2.1 to 7.0). Free medication on its own did not help (difference 0.5 points).
Quit rates were low in every arm, which is the honest starting point. But a screening visit is a rare moment when a smoker meets the health system worried about cancer, and this shows a referral slip alone does very little. Payment schemes are not standard in India; the transferable lesson is that passive referral is not enough.
- Offer cessation support in person at the screening visit rather than a referral slip alone
- Prescribe cessation medication actively and follow up, since simply making it available did not raise quit rates
- Confirm quitting with a carbon monoxide or cotinine check where you can
- Expect low absolute quit rates in this group and plan repeated attempts
Why it matters
It shows the default cessation offer attached to screening barely moves quit rates in the people at highest risk.
Don't overread it
Even the best arm left more than nine in ten people still smoking at six months.
The statistics, in plain English
A 4.6-point difference sounds small, but it roughly doubles the quit rate, so about one extra sustained quitter for every 22 people offered incentives. The confidence interval (2.1 to 7.0) sits wholly above zero, so the benefit is unlikely to be chance.
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