title: Patient navigation and financial incentives to promote smoking cessation in an underserved primary care population: A randomized controlled trial protocol.
abstract: Despite the high risk of tobacco-related morbidity and mortality among low-income persons, few studies have connected low-income smokers to evidence-based treatments. We will examine a smoking cessation intervention integrated into primary care. To begin, we completed qualitative formative research to refine an intervention utilizing the services of a patient navigator trained to promote smoking cessation. Next, we will conduct a randomized controlled trial combining two interventions: patient navigation and financial incentives. The goal of the intervention is to promote smoking cessation among patients who receive primary care in a large urban safety-net hospital. Our intervention will encourage patients to utilize existing smoking cessation resources (e.g., quit lines, smoking cessation groups, discussing smoking cessation with their primary care providers). To test our intervention, we will conduct a randomized controlled trial, randomizing 352 patients to the intervention condition (patient navigation and financial incentives) or an enhanced traditional care control condition. We will perform follow-up at 6, 12, and 18 months following the start of the intervention. Evaluation of the intervention will target several implementation variables: reach (participation rate and representativeness), effectiveness (smoking cessation at 12 months [primary outcome]), unintended consequences (e.g., purchase of illicit substances with incentive money), adoption (use of intervention across primary care suites), implementation (delivery of intervention), and maintenance (smoking cessation after conclusion of intervention). Improving the implementation of smoking cessation interventions in primary care settings serving large underserved populations could have substantial public health impact, reducing cancer-related morbidity/mortality and associated health disparities.
authors.affiliation: Boston University, School of Medicine, Section of General Internal Medicine, 801 Massachusetts Ave., Crosstown Center, 2nd Floor, Boston, MA 02118, USA; Boston University, School of Public Health, Department of Community Health Sciences, 801 Massachusetts Ave. Crosstown Center, 4th Floor, Boston, MA 02118, USA. Electronic address: Lmquinti@bu.edu.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Quintiliani
authors.affiliation: Boston University, Center for Psychiatric Rehabilitation, 940 Commonwealth Ave., West, Boston, MA 02215, USA. Electronic address: zlatka@bu.edu.
authors.forename: Zlatka L
authors.initials: ZL
authors.lastname: Russinova
authors.affiliation: Boston University, Center for Psychiatric Rehabilitation, 940 Commonwealth Ave., West, Boston, MA 02215, USA. Electronic address: bloch@bu.edu.
authors.forename: Philippe P
authors.initials: PP
authors.lastname: Bloch
authors.affiliation: Boston University, School of Medicine, Section of General Internal Medicine, 801 Massachusetts Ave., Crosstown Center, 2nd Floor, Boston, MA 02118, USA. Electronic address: ve.truong@bmc.org.
authors.forename: Ve
authors.initials: V
authors.lastname: Truong
authors.affiliation: Boston University, School of Public Health, Department of Community Health Sciences, 801 Massachusetts Ave. Crosstown Center, 4th Floor, Boston, MA 02118, USA. Electronic address: zxuan@bu.edu.
authors.forename: Ziming
authors.initials: Z
authors.lastname: Xuan
authors.affiliation: University of Massachusetts Medical School, Department of Medicine, Division of Preventive and Behavioral Medicine, 55 Lake Ave. North, Worcester, MA 01655, USA. Electronic address: lori.pbert@umassmed.edu.
authors.forename: Lori
authors.initials: L
authors.lastname: Pbert
authors.affiliation: Boston University, School of Medicine, Section of General Internal Medicine, 801 Massachusetts Ave., Crosstown Center, 2nd Floor, Boston, MA 02118, USA; Boston University, School of Public Health, Department of Community Health Sciences, 801 Massachusetts Ave. Crosstown Center, 4th Floor, Boston, MA 02118, USA. Electronic address: karen.lasser@bmc.org.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Lasser
mesh_terms: D000367:Age Factors; D006293:Health Promotion / Q000458:organization & administration; D006801:Humans; D062526:Patient Navigation / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D012201:Reward; D064876:Safety-net Providers / Q000458:organization & administration*; D020377:Self Efficacy; D012737:Sex Factors; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D012944:Social Support; D012959:Socioeconomic Factors; D035862:Vulnerable Populations
keywords: Financial incentives; Patient navigation; Primary care; Smoking cessation; Underserved populations