Effect of Patient Navigation and Financial Incentives on Smoking Cessation Among Primary Care Patients at an Urban Safety-Net Hospital

Abstract

IMPORTANCE While the proportion of adults who smoke cigarettes has declined substantially in the past decade, socioeconomic disparities in cigarette smoking remain. Few interventions have targeted low socioeconomic status (SES) and minority smokers in primary care settings.OBJECTIVE To evaluate a multicomponent intervention to promote smoking cessation among low-SES and minority smokers. DESIGN, SETTING, AND PARTICIPANTS For this prospective, unblinded, randomized clinical trial conducted between May 1, 2015, and September 4, 2017, adults 18 years and older who spoke English, smoked 10 or more cigarettes per day in the past week, were contemplating or preparing to quit smoking, and had a primary care clinician were recruited from general internal medicine and family medicine practices at 1 large safety-net hospital in Boston, Massachusetts.INTERVENTIONS Patients were randomized to a control group that received an enhancement of usual care (n = 175 participants) or to an intervention group that received up to 4 hours of patient navigation delivered over 6 months in addition to usual care, as well as financial incentives for biochemically confirmed smoking cessation at 6 and 12 months following enrollment (n = 177 participants). MAIN OUTCOMES AND MEASURESThe primary outcome determined a priori was biochemically confirmed smoking cessation at 12 months. RESULTS Among 352 patients who were randomized (mean [SD] age, 50.0 [11.0] years; 191 women [54.3%]; 197 participants who identified as non-Hispanic black [56.0%]; 40 participants who identified as Hispanic of any race [11.4%]), all were included in the intention-to-treat analysis. At 12 months following enrollment, 21 participants [11.9%] in the navigation and incentives group, compared with 4 participants [2.3%] in the control group, had quit smoking (odds ratio, 5.8; 95% CI, 1.9-17.1; number needed to treat, 10.4; P < .001). In prespecified subgroup analyses, the intervention was particularly beneficial for older participants (19 [19.8%] vs 1 [1.0%]; P < .001), women (17 [16.8%] vs 2 [2.2%]; P < .001), participants with household yearly income of $20 000 or less (15 [15.5%] vs 3 [3.1%]; P = .003), and nonwhite participants (21 [15.2%] vs 4 [3.0%]; P < .001). CONCLUSIONS AND RELEVANCEIn this study of adult daily smokers at 1 large urban safety-net hospital, patient navigation and financial incentives for smoking cessation significantly increased the rates of smoking cessation. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02351609

Systematic review of behavioural smoking cessation interventions for older smokers from deprived backgrounds

“…Eleven studies met the inclusion criteria (figure 1). Nine of the 11 studies were quantitative28–36 and two were mixed-methods design37 38. Three studies were randomised control trials, with the remaining using a range of non-randomised designs.…”

“…Nine studies used a combination of nicotine replacement therapy and behavioural counselling28–30 32–37. One study used only nicotine replacement therapy31 and one used behavioural counselling without nicotine replacement therapy38.…”

Should We Pay the Smokers? A Meta-Analysis of Financial Incentives for Smoking Cessation Among Smokers in Low Socioeconomic Group

“…The shape and symmetry of the funnel plot of log ORs from the six studies as shown in Figure 2 suggest that there is minimal publication bias present. All of the studies have high precision except for one study 35 . Figure 2.…”

“…Among them; ten studies using different intervention other than financial incentive such as psychosocial intervention; 17 studies have different outcome measure such as measuring quality of life and tobacco cessation service engagement; five studies had different target population other than low-income or socially disadvantages smoker; and one study measuring cost-effectiveness of financial incentive for smoking cessation among low income smoker. Six remaining articles 20,21,[33][34][35][36] were included for meta-analysis. A flow diagram describing the article retrieval based on PRISMA flow diagram 26 is provided in Figure 1.…”

“…All studies were RCTs study design. Five studies were conducted in United States 20,21,33,35,36 and one study from Switzerland 34 . One study conducted among pregnant women 20 and one in mentally-ill adult 33 while others study participant were…”