Park Elyse R, Haas Jennifer S, Rigotti Nancy A, Neil Jordan M, Marotta Caylin J, Wint Amy J, Gonzalez Irina, McGovern Sydney E, Chang Yuchiao, Levy Douglas E, Flores Efren J, Merker Vanessa L, Noonan Elise, Bliss Cayley C
Health Promotion and Resiliency and Intervention Research Program, Massachusetts General Hospital, Harvard Medical School, Boston.
Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston.
JAMA Intern Med. 2025 May 1;185(5):531-539. doi: 10.1001/jamainternmed.2024.8399.
Integrating tobacco treatment into lung cancer screening (LCS) could increase smoking cessation among older smokers by leveraging a teachable moment and treatment access.
To identify effective evidence-based tobacco treatment components for individuals undergoing LCS.
DESIGN, SETTING, AND PARTICIPANTS: A 2 × 2 × 2 factorial randomized clinical trial offered to adults aged 50 to 80 years who spoke English or Spanish and were scheduled for LCS at 11 outpatient imaging sites from April 2019 to June 2023.
Individuals were randomized to 8 groups of a multicomponent intervention with 3 treatment factors: duration of telehealth counseling offered (4 sessions over 4 weeks vs 8 sessions over 12 weeks), duration of free nicotine replacement therapy (NRT) provided (2 vs 8 weeks), offer of screening for social determinants of health (SDOH), and referral to community-based resources (yes or no).
Primary outcome was self-reported 7-day tobacco abstinence at 6-month follow-up.
A total of 642 individuals were randomized (mean [SD] age, 64 [6.5] years; 358 [55.8%] female; 67 (10.4%) identified as Black, 47 (7.3%) identified as Hispanic, 540 (84.1%) identified as White; 207 [32.3%] had high school education or less; 36.3 [19.4] mean [SD] pack-years; mean [SD] 16.2 [8.2] cigarettes per day; 484 [75.4%] smoked within 30 minutes after waking). At 6 months, 7-day abstinence was higher for individuals offered 8 vs 4 counseling sessions (17.3% vs 11.7%; risk difference, 5.6; 95% CI, 0.1-11.0; P = .045) but was not significantly different by duration of NRT provision or offer of SDOH screening or referral. In exit interviews, individuals expressed support for more counseling and medication choice and identified barriers to SDOH screening uptake.
In this randomized clinical trial among current smokers undergoing LCS, an integrated, centralized tobacco treatment program offering a longer duration of counseling produced greater tobacco abstinence at 6 months, but providing a longer duration of NRT or offering SDOH screening and referral in this context did not. In future work, strategies to expand medication usage and promote SDOH screening might be explored.
ClinicalTrials.gov Identifier: NCT03611881.
将烟草治疗纳入肺癌筛查（LCS）可利用可教时刻和治疗途径，增加老年吸烟者的戒烟率。
确定接受LCS的个体有效的循证烟草治疗组成部分。
设计、地点和参与者：一项2×2×2析因随机临床试验，面向年龄在50至80岁、讲英语或西班牙语、计划于2019年4月至2023年6月在11个门诊影像站点接受LCS的成年人。
个体被随机分为8组，接受多组分干预，有3个治疗因素：提供的远程医疗咨询时长（4周内4次咨询 vs 12周内8次咨询）、提供的免费尼古丁替代疗法（NRT）时长（2周 vs 8周）、提供健康社会决定因素（SDOH）筛查以及转介至社区资源（是或否）。
主要结局是在6个月随访时自我报告的7天戒烟情况。
共有642人被随机分组（平均[标准差]年龄为64[6.5]岁；358人[55.8%]为女性；67人（10.4%）为黑人，47人（7.3%）为西班牙裔，540人（84.1%）为白人；207人（32.3%）接受过高中及以下教育；平均[标准差]吸烟包年数为36.3[19.4]；平均[标准差]每天吸16.2[8.2]支烟；484人（75.4%）在醒来后30分钟内吸烟）。在6个月时，接受8次咨询的个体7天戒烟率高于接受4次咨询的个体（17.3%对11.7%；风险差异为5.6；95%置信区间为0.1 - 11.0；P = 0.045），但在提供NRT的时长、提供SDOH筛查或转介方面无显著差异。在退出访谈中，个体表示支持更多咨询和药物选择，并指出了SDOH筛查采用的障碍。
在这项针对接受LCS的当前吸烟者的随机临床试验中，一个综合的、集中的烟草治疗项目提供更长时长的咨询，在6个月时产生了更高的戒烟率，但在此背景下提供更长时长的NRT或提供SDOH筛查及转介并未产生此效果。在未来的工作中，可能会探索扩大药物使用和促进SDOH筛查的策略。
ClinicalTrials.gov标识符：NCT03611881。
