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

Darla E Kendzor; Morgan Davie; Meng Chen; Jonathan Hart; Summer G Frank-Pearce; Mark P Doescher; Adam C Alexander; Michael S Businelle; Motolani E Ogunsanya; Munjireen S Sifat; Laili Kharazi Boozary

doi:10.1016/j.amepre.2024.10.014

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

Am J Prev Med. 2024 Oct 29:S0749-3797(24)00366-0. doi: 10.1016/j.amepre.2024.10.014. Online ahead of print.

Affiliations

¹ Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences, Oklahoma City, Oklahoma; TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences, Oklahoma City, Oklahoma. Electronic address: [email protected].
² TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences, Oklahoma City, Oklahoma.
³ TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences, Oklahoma City, Oklahoma; Department of Pediatrics, The University of Oklahoma Health Sciences, Oklahoma City, Oklahoma.
⁴ Department of Pediatrics, The University of Oklahoma Health Sciences, Oklahoma City, Oklahoma.
⁵ TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences, Oklahoma City, Oklahoma; Department of Biostatistics and Epidemiology, Hudson College of Public Health, The University of Oklahoma Health Sciences, Oklahoma City, Oklahoma.
⁶ Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences, Oklahoma City, Oklahoma; Community Outreach and Engagement, Stephenson Cancer Center, The University of Oklahoma Health Sciences, Oklahoma City, Oklahoma.
⁷ Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences, Oklahoma City, Oklahoma; TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences, Oklahoma City, Oklahoma.
⁸ Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania.

PMID: 39477130
DOI: 10.1016/j.amepre.2024.10.014

Abstract

Introduction: Persistent poverty counties (PPCs) are U.S. counties where ≥20% of residents have lived in poverty for ≥30 years. Cancer mortality rates in PPCs are exceptionally high due, in part, to elevated smoking rates.

Study design: The study used a parallel 2-group randomized controlled trial design.

Setting/participants: Participants were Oklahoma Tobacco Helpline (OTH) callers from PPCs who smoked daily (N=165). Data were collected in 2022-2023.

Intervention: Participants were randomized to received OTH treatment (coaching calls plus nicotine replacement therapy [NRT]) or OTH treatment + financial incentives (OTH+FI) for completing coaching calls.

Main outcome measures: Outcome measures included the number of coaching calls completed, call-contingent incentives earned, past 7-day self-reported abstinence rates, and study retention at 8- and 12-weeks post-enrollment.

Results: Participants (N=165) were predominantly female (63.6%), 24.2% were racially/ethnically minoritized (18.2% single- or multi-race American Indian), and they smoked an average of 21.01 (SD=11.67) cigarettes per day. Adjusted analyses indicated that participants assigned to OTH+FI were significantly more likely than those assigned to OTH to report past 7-day abstinence at the 8-week (AOR=2.28; 95% CI=1.18, 4.48) and 12-week (AOR=2.00; 95% CI=1.03, 3.96) follow-ups when missing outcomes were considered smoking. Participants assigned to OTH+FI were more likely to complete ≥3 coaching calls (AOR=3.64; 95% CI=1.84, 7.43), and they completed more total calls (aRR=1.53; 95% CI,=1.24, 1.90) than those assigned to OTH. The number of coaching calls completed significantly mediated the relationship between treatment group assignment and abstinence at the 8- and 12-week follow-ups. Overall, study retention was >83% at the 8- and 12-week follow-ups and did not differ between groups. Statistical analyses were conducted in 2024.

Conclusions: Findings support the feasibility and efficacy of offering small FI for completing OTH coaching calls to increase treatment engagement and smoking cessation in PPCs.

Grants and funding

P30 CA225520/CA/NCI NIH HHS/United States