Re-engagement of Low-Income Smokers in Quitline Services: Effects of Incentives and Method of Contact
Author:
Cummins Sharon E1,
Kirby Carrie A1,
Wong Shiushing1,
Anderson Christopher M1,
Zhu Shu-Hong12ORCID
Affiliation:
1. Moores Cancer Center, University of California, San Diego , La Jolla, CA , USA
2. Herbert Wertheim School of Public Health, University of California , San Diego, La Jolla, CA , USA
Abstract
Abstract
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.
Aims and Methods
Randomly selected Medicaid smokers (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 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 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
Low-income smokers 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 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.
Funder
Centers for Medicare & Medicaid Services
California’s Tobacco-Related Disease Research Program
U.S. Department of Health and Human Services
Medicaid Incentives for Prevention of Chronic Diseases
California Department of Public Health
Centers for Disease Control and Prevention
University of California, San Diego
Publisher
Oxford University Press (OUP)
Subject
Public Health, Environmental and Occupational Health
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