Re-engagement of Low-income Smokers in Quitline Services: Effects of Incentives and Method of Contac
Thursday, November 17, 2022
Posted by: Natalia Gromov
Cummins SE, Kirby CA, Wong
S, Anderson CM, Zhu SH.
Re-engagement of
Low-income Smokers in Quitline Services: Effects of Incentives and Method of
Contact.
[published online ahead of print, 2022 Oct 22]. Nicotine Tob Res.
2022;ntac246. doi:10.1093/ntr/ntac246
Introduction. Financial
incentives have been shown to improve recruitment of low-income smokers into
tobacco quitline services and to improve cessation outcomes. The present study
evaluated their use to re-engage low-income smokers who had already used a
quitline.
Methods. Randomly
selected Medicaid smokers (N=5,200) who had previously enrolled in a quitline
were stratified by time since enrollment (3, 6, 9, or 12 months) and randomly
assigned in a 2x4 factorial design to receive, by mail or telephone, an
invitation to re-engage, with an offer of no financial incentive or $10, $20,
or $40. The primary outcome measure was re-engagement, defined as use of an
additional evidence based quitline service within 90 days. Data were collected
from May 2014 to October 2015 and analyzed in 2022.
Results. Of
5,200 participants invited to re-engage in quitline services, 9.3% did so within
90 days, compared to 6.3% of a randomly selected comparison group (n=22,614,
p<0.0001). Letters resulted in greater re-engagement than calls (10.9% vs.
7.8%, respectively, p=0.0001). Among letters, there was a dose-response
relationship between incentive level and re-engagement rates (p=0.003).
Re-engagement decreased as time since enrollment increased, from 13.7% at 3
months to 5.7% at 12 months (all p's<0.0001).
Conclusions. Low-income
smokers who previously used quitline services can be motivated to re-engage in
treatment. Mailed letters and automated calls are effective re-engagement
strategies. Financial incentives can increase the effectiveness of
re-engagement letters. Inviting Medicaid smokers to re-engage with quitline
treatment may help to address socioeconomic health disparities and should be
standard practice.
Implications. Nicotine
addiction is a chronic relapsing disorder, yet most cessation services are
designed to help smokers through only one quit attempt. Smoking is increasingly
concentrated in populations with physical and psychological co-morbidities,
which can make quitting more difficult and impact whether smokers reach out for
additional help following relapse. This study examined whether the timing,
method, and content of an offer for further assistance influenced re-engagement
rates for a vulnerable population of smokers-Medicaid beneficiaries. Relapsing
smokers are responsive to re-engagement offers as early as three months, but
there is a closing window of opportunity to reach them.
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