Financial Incentives Raise Verified Quit Rates from 4.3% to 8.8% in Underserved Lung Screening Patients

The multicenter RCT randomized participants referred for lung cancer screening across five U.S. systems into four arms. The incentive group received free pharmacotherapy and escalating payments contingent on verified abstinence, reaching 8.8% six-month cessation versus 4.3% in usual care; abstinence was confirmed by blood or urine cotinine. Most enrollees had long smoking histories, lower incomes, or lived in rural areas.

Prior incentive trials, such as the 2015 NEJM study by Halpern et al., showed similar relative gains in healthier populations, yet this JAMA study extends the finding to groups with documented barriers. The absolute increase of 4.5 percentage points remains modest, indicating incentives address motivation but not all structural obstacles. Integration with existing screening programs offers a scalable touchpoint that prior observational data linked to higher treatment uptake.

Open questions include payer coverage, long-term relapse rates beyond six months, and whether net healthcare savings justify program costs. Follow-up trials must measure cardiovascular and cancer incidence endpoints while testing lower incentive amounts to determine minimum effective thresholds.