Re-engagement of Low-income Smokers in Quitline Services: Effects of Incentives and Method of Contac

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
Nicotine Tob Res. 2023 Mar 22;25(4):796-802. doi: 10.1093/ntr/ntac246. PMID: 36271898.

Introduction. Financial incentives have been shown to improve the recruitment of people with lower incomes who smoke into tobacco quitline services and to improve cessation outcomes. The present study evaluated their use to reengage people with lower incomes who had already used a quitline.

Aims and methods. Randomly selected Medicaid members who smoke (N = 5200) who had previously enrolled in a quitline were stratified by time since enrollment (3, 6, 9, or 12 months) and randomly assigned in a 2 × 4 factorial design to receive, by mail or telephone, an invitation to reengage, with an offer of no financial incentive or $10, $20, or $40. The primary outcome measure was re-engagement, defined as using an additional evidence-based quitline service within 90 days. Data were collected from May 2014 to October 2015 and analyzed in 2022.

Results. Of 5200 participants invited to reengage in quitline services, 9.3% did so within 90 days, compared to 6.3% of a randomly selected comparison group (n = 22 614, p < .0001). Letters resulted in greater re-engagement than calls (10.9% vs. 7.8%, respectively, p = .0001). Among letters, there was a dose-response relationship between incentive level and re-engagement rates (p = .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. People who smoke and have lower incomes who previously used quitline services can be motivated to reengage in treatment. Mailed letters and automated calls are effective re-engagement strategies. Financial incentives can increase the effectiveness of re-engagement letters. Inviting people with Medicaid to reengage 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 people who smoke through only one quit attempt. Smoking is increasingly concentrated in populations with physical and psychological co-morbidities, making quitting more difficult and impacting whether people who smoke seek 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. People who relapse are responsive to re-engagement offers as early as three months, but there is a closing window of opportunity to reach them.