Predictors of Enrollment of Older Smokers in Six Smoking CessationTrials in the Lung Cancer Screening Setting:The Smoking Cessation at Lung Examination (SCALE) Collaboration

on behalf of the SCALE Collaboration

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Significance: Increased rates of smoking cessation will be essential to maximize the population benefit of low-dose CT screening for lung cancer.The NCI’s Smoking Cessation at Lung Examination (SCALE) Collaboration includes eight randomized trials, each assessing evidence-based interventions among smokers undergoing lung cancer screening (LCS). We examined predictors of trial enrollment to improve future outreach efforts for cessation interventions offered to older smokers in this and other clinical settings. Methods: We included the six SCALE trials that randomized individual participants. We assessed demographics, intervention modalities, LCS site and trial administration characteristics, and reasons for declining. Results: Of 6285 trial- and LCS-eligible individuals, 3897 (62%) declined and 2388 (38%) enrolled. In multivariable logistic regression analyses, Blacks had higher enrollment rates (OR 1.5, 95% CI 1.2,1.8) compared to Whites. Compared to “NRT Only” trials, those approached for “NRT + prescription medication” trials had higher odds of enrollment (OR 6.1, 95% CI 4.7,7.9). Regarding enrollment methods, trials using “Phone + In Person” methods had higher odds of enrollment (OR 1.6, 95% CI 1.2,1.9) compared to trials using “Phone Only” methods. Some of the reasons for declining enrollment included “too busy” (36.6%), “not ready to quit” (8.2%), “not interested in research” (7.7%), and “not interested in the intervention offered” (6.2%). Conclusion: Enrolling smokers in cessation interventions in the LCS setting is a major priority that requires multiple enrollment and intervention modalities. Barriers to enrollment provide insights that can be addressed and applied to future cessation interventions to improve implementation in LCS and other clinical settings with older smokers. Implications: We explored enrollment rates and reasons for declining across six smoking cessation trials in the lung cancer screening setting. Offering multiple accrual methods and pharmacotherapy options predicted increased enrollment across trials. Enrollment rates were also greater among Blacks compared to Whites.The findings offer practical information for the implementation of cessation trials and interventions in the lung cancer screening context and other clinical settings, regarding intervention modalities that may be most appealing to older, long-term smokers.

Original languageEnglish (US)
Pages (from-to)2037-2046
Number of pages10
JournalNicotine and Tobacco Research
Issue number12
StatePublished - Dec 1 2021

Bibliographical note

Funding Information:
This research was funded by the National Cancer Institute: R01 CA207228 (Taylor), P30 CA051008 (Weiner). R01 CA207078 (Cinciripini), P30 CA016672 (Pisters), R01 CA196873 (Joseph), R01 CA207442 (Ostroff/ Shelley), P30CA008748 (Thompson), R01CA218123 (Park/Rigotti/Haas), R01 CA207229 (Toll), K07CA214839 (Rojewski), R01CA207158 (Foley). The research was also supported in part by the generous philanthropic contributions to The University of Texas MD Anderson Moon Shots Program. The content of this article reflects the views of the authors. The funders had no role in the design of the study; the collection, analysis, and interpretation of the data; the writing of the manuscript; and the decision to submit the manuscript for publication.

Publisher Copyright:
© The Author(s) 2021. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.


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