Financial incentives and proactive calling for reducing barriers to tobacco treatment among socioeconomically disadvantaged women: A factorial randomized trial

Michael J. Parks, Kelly D. Hughes, Paula A. Keller, Randi B. Lachter, John H. Kingsbury, Christina L. Nelson, Jonathan S. Slater

    Research output: Contribution to journalArticlepeer-review

    2 Scopus citations

    Abstract

    Improved strategies and scalable interventions to engage low-socioeconomic status (SES) smokers in tobacco treatment are needed. We tested an intervention designed to connect low-SES smokers to treatment services, implemented through Minnesota's National Breast and Cervical Cancer Early Detection Program (Sage) in 2017; the trial was designed to last 3 months (July through October). Participants were female smokers who were 250% below the federal poverty level (randomized N = 3723; analyzed N = 3365). Using a factorial design, participants were randomized to six intervention groups consisting of a proactive call (no call vs call) and/or a financial incentive offered for being connected to treatment services ($0 vs $10 vs $20). Simple randomization was conducted using Stata v.13. All individuals received direct mail. Participants and staff were blinded to allocation. The outcome was connection via phone to QUITPLAN Services®, Minnesota's population-based cessation services. Groups that received $10 or $20 incentives had higher odds of treatment engagement compared to the no incentive group [respectively, OR = 1.94; 95% CI (1.19–3.14); OR = 2.18; 95% CI (1.36–3.51)]. Individuals that received proactive calls had higher odds of treatment engagement compared to individuals not called [OR = 1.59; 95% CI (1.11–2.29)]. Economic evaluation revealed that the $10 incentive, no call group had the best cost-benefit ratio compared to the no incentive, no call group. Direct mail with moderate incentives or proactive calling can successfully encourage connections to population-based tobacco treatment services among low-SES smokers. The intervention could be disseminated to similar programs serving low-SES populations. This trial is registered at ClinicalTrials.gov (NCT03760107).

    Original languageEnglish (US)
    Article number105867
    JournalPreventive medicine
    Volume129
    DOIs
    StatePublished - Dec 2019

    Bibliographical note

    Funding Information:
    This project is/was supported by the State of Minnesota and the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under National Research Service Award (NRSA) in Primary Medical Care, grant no. T32HP22239 (PI: Borowsky). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsement be inferred by the State of Minnesota, HRSA, HHS, or the U.S. Government.

    Funding Information:
    This project is/was supported by the State of Minnesota and the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under National Research Service Award (NRSA) in Primary Medical Care, grant no. T32HP22239 (PI: Borowsky). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsement be inferred by the State of Minnesota, HRSA, HHS, or the U.S. Government. The authors declare that there is no conflict of interest.

    Keywords

    • Financial incentives
    • Low-socioeconomic status female populations
    • Population-based interventions
    • Proactive calling
    • Tobacco control
    • Tobacco-related disparities

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