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Patient navigation, financial incentives improve smoking cessation rates

A multicomponent intervention that included patient navigation and financial incentives for biochemically confirmed smoking cessation significantly increased rates of smoking cessation among adult smokers, according to findings published in JAMA Internal Medicine.

“Tobacco use is the leading cause of preventable morbidity and mortality in the United States,” Karen E. Lasser MD, MPH, from Boston University, and colleagues wrote. “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 and minority smokers in primary care settings,” they added.

Between May 1, 2015, and Sept. 4, 2017, Lasser and colleagues performed a prospective, unblinded, randomized clinical trial to assess if a multicomponent intervention improved smoking cessation rates at 12 months among low-socioeconomic status and minority smokers.

The researchers enrolled 352 adults aged 18 years or older (mean age, 50 years; 54.3% women; 56% non-Hispanic black; 11.4% Hispanic) from a large safety-net hospital in Boston. Patients were eligible for enrollment if they smoked 10 or more cigarettes per day in the last week, were considering or preparing to quit smoking and had a primary care physician.

Participants were randomly selected to receive either an enhancement of usual care (n = 175; control) or usual care and up to four hours of guidance from a patient navigator to obtain appropriate health care services over 6 months and financial incentives for biochemically confirmed smoking cessation at 6 and 12 months (n = 177; intervention).

The researchers found that significantly more participants in the intervention group quit smoking after 12 months based on biochemical verification than those in the control group (11.9% vs. 2.3%; OR = 5.8; 95% CI, 1.9-17.1). Older participants (19.8% vs. 1%; P < .001), women (16.8% vs. 2.2%; P < .001), those with low household yearly income defined as $20,000 or less (15.5% vs. 3.1%; P = .003) and nonwhite participants (15.2% vs. 3%; P < .001) experienced the most benefit from the intervention.

“Future research should assess how the effectiveness of this intervention can be maximized and how health care systems can implement patient navigation and incentives into primary care,” they concluded. – by Alaina Tedesco

Disclosure: Lasser reports no relevant financial disclosures. Please see study for list of all other authors’ relevant financial disclosures.