This project seeks to identify ways to enhance the reach of evidence-based smoking cessation
treatments among adult primary care patients who smoke daily and are not ready to start
treatment at study enrollment. The 2x2x2x2 factorial experiment will evaluate the extent to
which 4 intervention components promote the use of evidence-based treatments to help smokers
not initially ready to quit to cease smoking over 2 years. The intervention components tested
include: modest financial incentives ($40) for completing an initial counseling session in a
smoking cessation treatment (vs. none); automated semi-annual outreach materials sent via
patients' preferred communication modality using data in the electronic health record to
tailor and personalize invitations to use available treatments to quit smoking (vs.
untailored letters); direct, proactive telephone outreach from a tobacco care manager who
will promote treatment use and deliver motivational intervention twice per year (vs. none);
and access to 3 no-cost telephone smoking cessation counseling calls with combination
nicotine replacement therapy (C-NRT) or varenicline (vs. state tobacco quitline and primary
care provider referral). Proactive treatment offers will be made up to 22 months after
enrollment. Smoking status and use of any smoking cessation treatments will be assessed every
6 months through 2 years of study enrollment. Data from 1664 adult primary care patients
meeting inclusion/exclusion criteria will be analyzed to see whether the intervention
components have an effect on the use of treatment (primary outcome) and smoking status after
2 years of treatment access (secondary outcome). The project will evaluate the manipulated
intervention components first in terms of treatment initiation (defined as rates of
completing at least 1 smoking cessation counseling session prior to a target stop-smoking
date), and then in terms of end-of-study (2 year post-enrollment) abstinence rates (secondary
outcome), and cost-effectiveness in promoting reach (tertiary outcome). This experiment will
help to identify health system reach interventions that effectively enhance utilization of
stop smoking treatments in an effort to help more smokers quit and to prevent tobacco-induced
cancer morbidity and mortality.