Financial incentives roughly double quit rates in underserved lung screening patients

Paying people to stop smoking, alongside free cessation medication, roughly doubled the proportion who had quit six months later in a large US trial. The participants were adults from medically underserved groups who had been referred for lung cancer screening. The results, from a team led by Joanna L. Hart and colleagues, were published in JAMA.

Trial design and main result

The randomised trial enrolled more than 3,200 adults at five health systems: Henry Ford Health, Penn Medicine, Lancaster General Health, Geisinger and Kaiser Permanente Southern California. Most participants came from groups that often face obstacles to good care, including people on lower incomes, rural residents, and Black and Hispanic adults.

The investigators compared four smoking cessation strategies. The source describes two of them in detail. Participants who received free cessation medication and could earn up to $600 in financial incentives had a six-month quit rate of 8.8%. Those given usual care had a rate of 4.3%. Abstinence was checked with blood or urine tests rather than self-report alone, which strengthens confidence in the outcome measure.

Why lung cancer screening is the setting

People attending lung cancer screening have, by definition, a substantial smoking history and therefore a raised risk of the disease. Screening can detect cancer earlier, but the visit also gives clinicians a natural moment to raise tobacco treatment. Mike Simoff, a pulmonologist at Henry Ford Health, said screening offers a chance to address a major risk factor as well as to look for disease.

Henry Ford Health already builds tobacco treatment into its centralised screening programme. Its service offers telephone counselling based on motivational interviewing, a method that helps people examine their reasons for smoking and plan behavioural change. Medications to reduce cravings and withdrawal symptoms can be added. Patients are not charged for the service.

The benefits of quitting extend beyond the lungs. Stopping smoking lowers the risk of other cancers and of cardiovascular disease, so gains in cessation could have wide effects on health.

Reading the numbers with care

The relative difference is large, but the absolute figures are modest. Even in the incentive arm, more than nine in ten participants had not quit at six months. The incentive approach is therefore best seen as one additional option rather than a solution on its own. The source does not provide results for the two remaining study arms, nor data on whether abstinence lasted beyond six months, so those questions need the full paper.

Christine Neslund-Dudas, a Henry Ford Health researcher and study investigator, noted that many participants had smoked for years and probably tried to quit before. She presented the findings as a further tool for people who face extra barriers.

Open questions for implementation

Several practical issues remain unresolved. It is unclear how incentives could be built into routine care, who would pay for them, and how large the long-term savings in health care costs might be. Researchers will also need to work out how such schemes can reach people with limited resources, who stand to gain most but may be hardest to engage.

For health services researchers, the trial offers a rigorously verified outcome in a population often underrepresented in cessation studies. Future work could examine cost-effectiveness, the durability of quitting, and how incentive size and delivery affect results when screening programmes adopt these measures.

Source: Financial incentives nearly double quit rates among underserved people who smoke in national study (Medical Xpress, 8 November 2026).

Image: AI-generated illustration.