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

Abstract

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. The study used a parallel 2-group randomized controlled trial design. Participants were Oklahoma Tobacco Helpline (OTH) callers from PPCs who smoked daily (N=165). Data were collected in 2022-2023. 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. 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. 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. Findings support the feasibility and efficacy of offering small FI for completing OTH coaching calls to increase treatment engagement and smoking cessation in PPCs.