Financial Incentives may Improve Smoking Cessation in Medically Underserved Adults: JAMA
Among medically underserved adults who smoke and were referred for lung cancer screening, adding financial incentives to ask-advise-refer resulted in higher rates of sustained tobacco abstinence through 6 months compared with ask-advise-refer alone or with free pharmacotherapy. The study was published in JAMA by Joanna L. and colleagues.
To determine which intervention is the most effective for underprivileged populations, researchers carried out a randomized clinical trial among four US health systems, involving five clinical centers. The screening of participants started on May 17, 2021, and lasted until last follow-up on April 29, 2025.
In total, 9,963 participants were screened, and 3,259 actively smoking participants, identifying as Black, Hispanic, rural residents, or belonging to a low socioeconomic status group, were randomized to receive interventions.
Out of those, 3,220 participants entered the primary analysis in four intervention groups: (1) ask-advise-refer usual care; (2) usual care plus free pharmacotherapy (nicotine replacement therapy and reimbursement of varenicline or bupropion); (3) usual care, free pharmacotherapy, and financial incentives of up to $600 based on cessation confirmation; and (4) usual care, free pharmacotherapy, financial incentives, and motivational mHealth intervention.
The primary outcome was biochemically confirmed sustained tobacco abstinence at 6 months with the use of cotinine, anabasine, or carboxyhemoglobin biomarkers.
Key findings:
- The analysis of 3,220 participants of the trial (age, median of 61.1 years [IQR, 56.6–66.0]; 1,948 women [60.3%]; 823 Blacks [25.5%]; 287 Hispanics [8.9%]; 1,251 rural [38.8%]; 1,519 with low socioeconomic status [74.9%]; 1,792 smoking >10 cigarettes/day [55.5%]) indicated the presence of specific quantitative therapeutic inequities.
- Biochemically confirmed rates of sustained tobacco abstinence through 6 months were 4.3% in the usual care group, 5.1% in the pharmacotherapy group, 8.8% in the financial incentives group, and 7.2% in the financial incentives plus mHealth group.
- The introduction of financial incentives was associated with a significant increase in adjusted rates of sustained tobacco abstinence compared with the usual care only (absolute difference, 4.6% [95% CI, 2.1%–7.0%]; P < 0.001) and compared with the usual care plus free pharmacotherapy (absolute difference, 4.1% [95% CI, 1.7%–6.4%]; P < 0.001).
- The provision of free pharmacotherapy, in addition to the usual ask-advise-refer procedures, did not prove superior over the usual care (absolute difference, 0.5% [95% CI, −1.7% to 2.6%]; P = 0.66).
It can be concluded that from real world randomized trials, the inclusion of financial rewards in the process of lung cancer screening helps significantly increase long-term tobacco cessation amongst medically underprivileged people. From the conclusions of the study, it can be said that the combination of financial rewards along with clinical care is an extremely effective approach.
Reference:
Hart JL, Vachani A, Neslund-Dudas CM, et al. Smoking Cessation Among Underserved Patients Referred for Lung Cancer Screening: A Randomized Clinical Trial. JAMA. Published online October 05, 2026. doi:10.1001/jama.2026.17192
