Comparing Smoking Cessation Interventions Among Underserved Patients Referred for Lung Cancer Screening

Low-dose computed tomography (LDCT) screening reduces mortality among people who smoke (currently and formerly) at high risk for lung cancer and is widely recommended by national guidelines. LDCT also increases access to care and thus provides an opportunity to deliver smoking cessation interventions to people who currently smoke in conjunction with this screening. As the burdens of smoking are greatest (and the effectiveness of standard interventions lowest) among patients who are Black, Hispanic, from rural residences, and/or are less educated or have lower incomes, such underserved patients are at high risk for poor smoking-associated health outcomes. Correspondingly, they may stand to benefit preferentially from smoking cessation interventions delivered in conjunction with LDCT. However, it is unknown which interventions best promote cessation in the screening context. By comparing standard with incrementally more intensive interventions, this trial among 3,200 individuals who currently smoke, will address the uncertainty health systems face regarding how best to help people who smoke and are at high-risk to quit. This study tests four incrementally more intensive interventions: 1) usual care; 2) pharmacologic cessation aids, 3) financial incentives, and 4) episodic future thinking mobile tool.