Incentives for Smoking Cessation in Underserved Patients, Nicotinamide Riboside for Parkinson Disease, Advanced Care Planning, Heat-Related Mortality by Occupation, and more

Cigarette smoking remains the leading cause of preventable morbidity and mortality worldwide.

Yet approximately 10% of Americans continue to smoke, and in many regions of the world, the number of smokers exceeds 20% of the population.

Thanks, Kirsten.

In this pragmatic randomized clinical trial, Dr. Hart and colleagues compared four approaches in 3,220 adults who were currently smoking and had been referred for lung cancer screening across five U.S. centers.

The trial participants who identified as Black, Hispanic, living in a rural area, or being of low socioeconomic status were assigned to one of four strategies.

The first, the ask, advise, refer to smoking cessation service approach, which was considered the usual care group, the second, usual care plus free pharmacotherapy, the third, usual care plus free pharmacotherapy and financial incentives of up to $600, or the fourth strategy, which was this entire package plus a motivational mobile health tool.

The primary outcome was biochemically confirmed sustained abstinence from tobacco through six months, which was observed in 4.3% with usual care, 5.1% with free pharmacotherapy, 8.8% with financial incentives, and 7.2% with the added mobile health tool.

The conclusion was that financial incentives improved quit rates.

while free pharmacotherapy alone did not add much to usual care.

For clinicians and health systems, the results suggest that if the goal is scalable, cash incentives may do more than simply offering medication.

That's a really important distinction, especially for programs trying to reduce disparities in lung cancer outcomes.

In an accompanying editorial, Dr. Kothuria and colleagues say that the trial reinforces a growing body of evidence that financial incentives for smoking cessation in socioeconomically disadvantaged populations can be effective.

They note that cessation rates in this trial were still low overall, but they argue that incentive-based approaches deserve attention.

They also emphasize that tobacco treatment should extend across the cancer care continuum and not stop at cancer screening.