Financial incentives and proactive calling for reducing barriers to tobacco treatment among socioeconomically disadvantaged women: A factorial randomized trial

Michael J. Parks; Kelly D. Hughes; Paula A. Keller; Randi B. Lachter; John H. Kingsbury; Christina L. Nelson; Jonathan S. Slater

doi:10.1016/j.ypmed.2019.105867

Financial incentives and proactive calling for reducing barriers to tobacco treatment among socioeconomically disadvantaged women: A factorial randomized trial

Michael J. Parks, Kelly D. Hughes, Paula A. Keller, Randi B. Lachter, John H. Kingsbury, Christina L. Nelson, Jonathan S. Slater

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3 Scopus citations

Abstract

Improved strategies and scalable interventions to engage low-socioeconomic status (SES) smokers in tobacco treatment are needed. We tested an intervention designed to connect low-SES smokers to treatment services, implemented through Minnesota's National Breast and Cervical Cancer Early Detection Program (Sage) in 2017; the trial was designed to last 3 months (July through October). Participants were female smokers who were 250% below the federal poverty level (randomized N = 3723; analyzed N = 3365). Using a factorial design, participants were randomized to six intervention groups consisting of a proactive call (no call vs call) and/or a financial incentive offered for being connected to treatment services ($0 vs $10 vs $20). Simple randomization was conducted using Stata v.13. All individuals received direct mail. Participants and staff were blinded to allocation. The outcome was connection via phone to QUITPLAN Services®, Minnesota's population-based cessation services. Groups that received $10 or $20 incentives had higher odds of treatment engagement compared to the no incentive group [respectively, OR = 1.94; 95% CI (1.19–3.14); OR = 2.18; 95% CI (1.36–3.51)]. Individuals that received proactive calls had higher odds of treatment engagement compared to individuals not called [OR = 1.59; 95% CI (1.11–2.29)]. Economic evaluation revealed that the $10 incentive, no call group had the best cost-benefit ratio compared to the no incentive, no call group. Direct mail with moderate incentives or proactive calling can successfully encourage connections to population-based tobacco treatment services among low-SES smokers. The intervention could be disseminated to similar programs serving low-SES populations. This trial is registered at ClinicalTrials.gov (NCT03760107).

Original language	English (US)
Article number	105867
Journal	Preventive medicine
Volume	129
DOIs	https://doi.org/10.1016/j.ypmed.2019.105867
State	Published - Dec 2019

Bibliographical note

Funding Information:
This project is/was supported by the State of Minnesota and the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under National Research Service Award (NRSA) in Primary Medical Care, grant no. T32HP22239 (PI: Borowsky). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsement be inferred by the State of Minnesota, HRSA, HHS, or the U.S. Government.

Funding Information:
This project is/was supported by the State of Minnesota and the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under National Research Service Award (NRSA) in Primary Medical Care, grant no. T32HP22239 (PI: Borowsky). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsement be inferred by the State of Minnesota, HRSA, HHS, or the U.S. Government. The authors declare that there is no conflict of interest.

Keywords

Financial incentives
Low-socioeconomic status female populations
Population-based interventions
Proactive calling
Tobacco control
Tobacco-related disparities

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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title = "Financial incentives and proactive calling for reducing barriers to tobacco treatment among socioeconomically disadvantaged women: A factorial randomized trial",

abstract = "Improved strategies and scalable interventions to engage low-socioeconomic status (SES) smokers in tobacco treatment are needed. We tested an intervention designed to connect low-SES smokers to treatment services, implemented through Minnesota's National Breast and Cervical Cancer Early Detection Program (Sage) in 2017; the trial was designed to last 3 months (July through October). Participants were female smokers who were 250% below the federal poverty level (randomized N = 3723; analyzed N = 3365). Using a factorial design, participants were randomized to six intervention groups consisting of a proactive call (no call vs call) and/or a financial incentive offered for being connected to treatment services ($0 vs $10 vs $20). Simple randomization was conducted using Stata v.13. All individuals received direct mail. Participants and staff were blinded to allocation. The outcome was connection via phone to QUITPLAN Services{\textregistered}, Minnesota's population-based cessation services. Groups that received $10 or $20 incentives had higher odds of treatment engagement compared to the no incentive group [respectively, OR = 1.94; 95% CI (1.19–3.14); OR = 2.18; 95% CI (1.36–3.51)]. Individuals that received proactive calls had higher odds of treatment engagement compared to individuals not called [OR = 1.59; 95% CI (1.11–2.29)]. Economic evaluation revealed that the $10 incentive, no call group had the best cost-benefit ratio compared to the no incentive, no call group. Direct mail with moderate incentives or proactive calling can successfully encourage connections to population-based tobacco treatment services among low-SES smokers. The intervention could be disseminated to similar programs serving low-SES populations. This trial is registered at ClinicalTrials.gov (NCT03760107).",

keywords = "Financial incentives, Low-socioeconomic status female populations, Population-based interventions, Proactive calling, Tobacco control, Tobacco-related disparities",

author = "Parks, {Michael J.} and Hughes, {Kelly D.} and Keller, {Paula A.} and Lachter, {Randi B.} and Kingsbury, {John H.} and Nelson, {Christina L.} and Slater, {Jonathan S.}",

note = "Funding Information: This project is/was supported by the State of Minnesota and the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under National Research Service Award (NRSA) in Primary Medical Care, grant no. T32HP22239 (PI: Borowsky). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsement be inferred by the State of Minnesota, HRSA, HHS, or the U.S. Government. Funding Information: This project is/was supported by the State of Minnesota and the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under National Research Service Award (NRSA) in Primary Medical Care, grant no. T32HP22239 (PI: Borowsky). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsement be inferred by the State of Minnesota, HRSA, HHS, or the U.S. Government. The authors declare that there is no conflict of interest.",

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doi = "10.1016/j.ypmed.2019.105867",

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T2 - A factorial randomized trial

AU - Parks, Michael J.

AU - Hughes, Kelly D.

AU - Keller, Paula A.

AU - Lachter, Randi B.

AU - Kingsbury, John H.

AU - Nelson, Christina L.

AU - Slater, Jonathan S.

N1 - Funding Information: This project is/was supported by the State of Minnesota and the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under National Research Service Award (NRSA) in Primary Medical Care, grant no. T32HP22239 (PI: Borowsky). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsement be inferred by the State of Minnesota, HRSA, HHS, or the U.S. Government. Funding Information: This project is/was supported by the State of Minnesota and the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under National Research Service Award (NRSA) in Primary Medical Care, grant no. T32HP22239 (PI: Borowsky). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsement be inferred by the State of Minnesota, HRSA, HHS, or the U.S. Government. The authors declare that there is no conflict of interest.

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N2 - Improved strategies and scalable interventions to engage low-socioeconomic status (SES) smokers in tobacco treatment are needed. We tested an intervention designed to connect low-SES smokers to treatment services, implemented through Minnesota's National Breast and Cervical Cancer Early Detection Program (Sage) in 2017; the trial was designed to last 3 months (July through October). Participants were female smokers who were 250% below the federal poverty level (randomized N = 3723; analyzed N = 3365). Using a factorial design, participants were randomized to six intervention groups consisting of a proactive call (no call vs call) and/or a financial incentive offered for being connected to treatment services ($0 vs $10 vs $20). Simple randomization was conducted using Stata v.13. All individuals received direct mail. Participants and staff were blinded to allocation. The outcome was connection via phone to QUITPLAN Services®, Minnesota's population-based cessation services. Groups that received $10 or $20 incentives had higher odds of treatment engagement compared to the no incentive group [respectively, OR = 1.94; 95% CI (1.19–3.14); OR = 2.18; 95% CI (1.36–3.51)]. Individuals that received proactive calls had higher odds of treatment engagement compared to individuals not called [OR = 1.59; 95% CI (1.11–2.29)]. Economic evaluation revealed that the $10 incentive, no call group had the best cost-benefit ratio compared to the no incentive, no call group. Direct mail with moderate incentives or proactive calling can successfully encourage connections to population-based tobacco treatment services among low-SES smokers. The intervention could be disseminated to similar programs serving low-SES populations. This trial is registered at ClinicalTrials.gov (NCT03760107).

AB - Improved strategies and scalable interventions to engage low-socioeconomic status (SES) smokers in tobacco treatment are needed. We tested an intervention designed to connect low-SES smokers to treatment services, implemented through Minnesota's National Breast and Cervical Cancer Early Detection Program (Sage) in 2017; the trial was designed to last 3 months (July through October). Participants were female smokers who were 250% below the federal poverty level (randomized N = 3723; analyzed N = 3365). Using a factorial design, participants were randomized to six intervention groups consisting of a proactive call (no call vs call) and/or a financial incentive offered for being connected to treatment services ($0 vs $10 vs $20). Simple randomization was conducted using Stata v.13. All individuals received direct mail. Participants and staff were blinded to allocation. The outcome was connection via phone to QUITPLAN Services®, Minnesota's population-based cessation services. Groups that received $10 or $20 incentives had higher odds of treatment engagement compared to the no incentive group [respectively, OR = 1.94; 95% CI (1.19–3.14); OR = 2.18; 95% CI (1.36–3.51)]. Individuals that received proactive calls had higher odds of treatment engagement compared to individuals not called [OR = 1.59; 95% CI (1.11–2.29)]. Economic evaluation revealed that the $10 incentive, no call group had the best cost-benefit ratio compared to the no incentive, no call group. Direct mail with moderate incentives or proactive calling can successfully encourage connections to population-based tobacco treatment services among low-SES smokers. The intervention could be disseminated to similar programs serving low-SES populations. This trial is registered at ClinicalTrials.gov (NCT03760107).

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KW - Proactive calling

KW - Tobacco control

KW - Tobacco-related disparities

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Financial incentives and proactive calling for reducing barriers to tobacco treatment among socioeconomically disadvantaged women: A factorial randomized trial

Abstract

Bibliographical note

Keywords

UN SDGs

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