ASPO Abstracts
Financial Incentives and Proactive Calling for Promoting Tobacco Treatment Engagement in a Low-income Population: A Factorial Randomized Trial
Category: Behavioral Science & Health Communication, Lifestyles Behavior, Energy Balance & Chemoprevention
Conference Year: 2018
Abstract Body:
The tobacco epidemic disproportionately affects low-socioeconomic populations. Improved strategies to engage low-income smokers in tobacco treatment are needed, particularly scalable interventions. Purpose: We tested a tobacco treatment engagement intervention for low-income smokers. Using a factorial design, individuals were randomized to financial incentive ($0 vs. $10 vs. $20) and proactive call (no call vs. call) conditions (six conditions). All individuals received direct mail and could opt for cessation support through QUITPLAN® Services, Minnesota’s population-based cessation services. Methods: The intervention was implemented through “Sage,” Minnesota's National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Sage provides cancer early detection services to low-income individuals experiencing health disparities. Sage data captured smoking status and demographics; primary engagement outcome was confirmed connection to QUITPLAN Services through Sage’s call center. Participants were smokers identified in Sage’s database from 2013 to 2016 with confirmed addresses (N=3,365). Logistic regression was used to examine (1) the direct effect of financial incentives and of proactive calls, and (2) the interaction between incentive levels and proactive calls. Cost effective analysis was also completed. Results: Groups that received $10 or $20 incentives had higher odds of treatment engagement compared to groups that received no incentive [respectively, OR=1.97; 95% CI (1.21— 3.23); OR=2.06; 95% CI (1.26—3.35)]. Also, groups that received a proactive call had higher odds of treatment engagement compared to groups not called [OR=1.50; 95% CI (1.04—2.17)]. Compared to the no-incentive, no-call group, the $20 incentive, call group had the highest odds of treatment engagement [OR=4.29; 95% CI (1.86— 9.87)]. The $10 incentive groups were the most cost effective. Conclusion: Direct mail with small incentives or proactive calling can successfully encourage low-income smokers to engage in tobacco treatment through population-based cessation programs. Other NBCCEDPs could consider implementing similar approaches to help reduce tobacco-related disparities.
Keywords: Tobacco treatment, engagement, incentive, multi-component, intervention