Integrating Tobacco Treatment Into Lung Cancer Screening

Importance Integrating tobacco treatment into lung cancer screening (LCS) could increase smoking cessation among older smokers by leveraging a teachable moment and treatment access. Objective 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. Interventions 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). Main Outcomes and Measures Primary outcome was self-reported 7-day tobacco abstinence at 6-month follow-up. Results 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. Conclusions and Relevance 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. Trial Registration ClinicalTrials.gov Identifier: NCT03611881