A pilot study assessing the addition of a Quit and Win program to pharmacist-led intensive smoking cessation therapy in a predominantly underserved, minority population
More details
Hide details
College of Pharmacy, The University of Texas at Austin, Austin, Texas, United States
Department of Pharmacy, University Health System, San Antonio, Texas, United States
Kirk E. Evoy   

Department of Pharmacy, University Health System, San Antonio, TX 78229, United States
Publish date: 2019-11-26
Submission date: 2019-08-27
Final revision date: 2019-10-07
Acceptance date: 2019-10-24
Tob. Prev. Cessation 2019;5(November):44
Quit and Win programs (Q&W) have been shown to improve smoking cessation rates by offering potential rewards to encourage smoking cessation. However, few studies have combined Q&W with intensive smoking cessation programs including behavioral counseling and pharmacotherapy, or studied Q&W in underserved, minority populations. This study was conducted to assess the impact on smoking cessation rates of adding a Q&W to intensive smoking cessation therapy in a largely underserved, minority population.

This was a single-center, prospective, open-label controlled study. Current smokers received pharmacist-led behavioral counseling and smoking cessation pharmacotherapy. Intervention group patients who successfully quit (verified by self-report and exhaled carbon monoxide) at 1 month and 3 months post-quit date were entered into a draw for $1000. The control group received the same smoking cessation services, but without a monetary incentive.

Enrollment was 111 patients (N=85 in the intervention group), made up of predominantly underserved (82% had annual household income <000), minority (69.1%), and female (58%) patients. Groups were similar except the intervention group had lower educational and income levels, while the control group was more likely to smoke more than 1 pack per day. Quit rates at 3 months were 27% and 19% in the intervention and control groups, respectively (p=0.22). Female gender (OR=2.84; p=0.04) and Fagerström score (OR=0.71; p<0.01) were significant predictors of quitting.

The addition of Q&W to intensive smoking cessation services increased clinic referrals and numerically improved cessation rates, although this difference was not statistically significant, possibly due to high attrition of the study.

The authors thank Karen Hudmon of the Purdue University College of Pharmacy for assistance with the final editing of the manuscript.
The authors have each completed and submitted an ICMJE form for disclosure of potential conflicts of interest. The authors declare that they have no competing interests, financial or otherwise, related to the current work. S.0. Nduaguba reports personal fees from The University of Texas at Austin College of Pharmacy, during the conduct of the study.
This work was supported by an academic research grant provided by The Arlyn Kloesel Endowment Grant Program for Innovative Pharmacy Practice and Business Models. No proposal number was provided for this grant. The funding source played no role in the study design, data collection, analysis, interpretation of data, or manuscript development.
KEE and KHF were primarily responsible for study design. KEE and AT carried out the study, with KEE leading all clinical services. SON and KHF were primarily responsible for statistical analysis. KEE and KHF were responsible for interpreting the study findings. KEE, LT and SON developed the first draft of the manuscript. All authors contributed to manuscript revisions.
Not commissioned; externally peer reviewed.
Yoon PW, Bastian B, Anderson RN, Collins JL, Jaffe HW. Potentially preventable deaths from the five leading causes of death – United States, 2008-2010. MMWR. 2016;65(45):1245-1255. doi:10.15585/mmwr.mm6545a1
Center for Disease Control and Prevention. Smoking-Attributable Mortality, Morbidity, and Economic Costs (SAMMEC) – Smoking-Attributable Expenditures (SAE). 2015. Accessed July 31, 2019.
Center for Disease Control and Prevention. Smoking & Tobacco Use: Fast Facts and Fact Sheets. Accessed July 31, 2019.
Leas EC, Pierce JP, Benmarhnia T, White MM, Noble ML, Trinidad DR, Strong DR. Effectiveness of pharmaceutical smoking cessation aids in a nationally representative cohort of American smokers. J Natl Cancer Inst. 2018;110(6):581-587. doi:10.1093/jnci/djx240
Ku L, Bruen BK, Steinmetz E, Bysshe T. Medicaid Tobacco Cessation: Big Gaps Remain In Efforts To Get Smokers to Quit. Health Aff. 2016;35(1):62-70. doi:10.1377/hlthaff.2015.0756
Pechacek TF, Lando HA, Nothwehr F, Lichtenstein E. Quit and Win: a community-wide approach to smoking cessation. Tob Control. 1994:3(3):236-241. Accessed July 31, 2019.
Cahill K, Perera R. Quit and win contests for smoking cessation. Cochrane Database Syst Rev. 2008;(4):CD004986. doi:10.1002/14651858.cd004986.pub2
Hahn EJ, Rayens MK, Warnick TA, et al. A controlled trial of a quit and win contest. Am J Health Promot. 2005;20(2):117-126. doi:10.4278/0890-1171-20.2.117
Hahn EJ, Rayens MK, Chirila C, Riker CA, Paul TP, Warnick TA. Effectiveness of a quit and win contest with a low-income population. Prev Med. 2004;39(3):543-550. doi:10.1016/j.ypmed.2004.02.012
McAlister AL, Gumina T, Urjanheimo EL, et al. Promoting smoking cessation in Russian Karelia: a 1-year community-based program with quasi-experimental evaluation. Health Promot Int. 2000;15(2):109-112. doi:10.1093/heapro/15.2.109
Volpp KG, Levy AG, Asch DA, et al.A randomized controlled trial of financial incentives for smoking cessation. Cancer Epidemiol Biomarkers Prev. 2006;15(1):12-18. doi:10.1158/1055-9965.epi-05-0314
Bains N, Pickett W, Laundry B, Mecredy D. Predictors of smoking cessation in an incentive-based community intervention. Chronic Dis Can. 2000;21(2):54-61. PMID:11007655.
Gomez-Coronado N, Walker AJ, Berk M, Dodd S. Current and Emerging Pharmacotherapies for Cessation of Tobacco Smoking. Pharmacotherapy. 2018;38(2):235-258. doi:10.1002/phar.2073
Hawk LW, Higbee C, Hyland A, Alford T, O’Connor R, Cummings KM. Concurrent quit and win and nicotine replacement therapy voucher giveaway programs: participant characteristics and predictors of smoking abstinence. J Public Health Management Practice. 2006;12(1):52-59. doi:10.1097/00124784-200601000-00011
Kiefe CI, Williams OD, Lewis CE, Allison JJ, Sekar P, Wagenknecht LE. Ten-year changes in smoking among young adults: are racial differences explained by socioeconomic factors in the CARDIA study?. Am J Public Health. 2001;91(2):213-218. doi:10.2105/ajph.91.2.213
Centers for Disease Control and Prevention. Women and Smoking: A Report of the Surgeon General. Washington, DC: US Dept of Health and Human Services; 2001. Accessed July 31, 2019.
O’Connor R, Fix B, Celestino P, Carlin-Menter S, Hyland A, Cummings KM. Financial incentives to promote smoking cessation: evidence from 11 Quit and Win contests. J Public Health Manag Pract. 2006;12(1):44-51. doi:10.1097/00124784-200601000-00010