Wisconsin Tobacco Quit Line Medicaid Incentive Evaluation

Not Applicable

Completed

Interventions: Behavioral: Counseling from WTQL
Other: Financial incentive to participate

Brief Summary: The study is designed to test the hypotheses that financial incentives can increase both participation in smoking cessation treatment and resulting cessation rates, when they are offered to BadgerCare Plus (Medicaid) smokers as part of their health care.

Detailed Description: Previous research on providing incentives for healthy behaviors has shown that financial incentives can increase treatment participation and boost outcomes when they are tied to participation in evidence based treatments. However, most of this research has been done in laboratory settings and in relatively small clinical trials. This study is designed to test the hypotheses that incentives can increase both participation in smoking cessation treatment and resulting cessation rates, when they are offered to Wisconsin BadgerCare Plus (Medicaid) smokers as part of their health care. If successful, this treatment approach could be used more broadly to reduce the considerable financial and personal costs associated with smoking-related disease.

In this study, Medicaid-eligible smokers were recruited from primary care clinics and from callers to the Wisconsin Tobacco Quit Line (WTQL) with randomization a Control condition and an Incentive condition. All participants were offered five cessation calls from the WTQL and participants were encouraged by WTQL coaches to obtain cessation medication from their primary care providers. All participants received payment for completing a baseline assessment ($40) and a 6-month smoking test ($40). Only Incentive condition participants received additional compensation for taking counseling calls ($30 per completed call) and for biochemically-verified abstinence at the 6-month visit ($40).

Recruitment & Eligibility

Inclusion Criteria

enrollment in Wisconsin Medicaid (BadgerCare Plus)
resides in study area (one of 25 counties)
18 or older
English or Spanish speaking
has smoked daily (at least 5 cigarettes each day) over the last week
willingness to attend visits at his/her PCC (primary care clinic) or go to a testing site at baseline and 6 months (2 times over a 6 month period), provide urine samples or participate in exhaled carbon monoxide testing, and complete follow-up phone calls from the WTQL
willingness to inform the WTQL as to any change in address, phone number, clinic attended, or health plan.

Exclusion Criteria

not enrolled in Wisconsin Medicaid (BadgerCare Plus)
not reside in study area
less than 18 years of age
not English or Spanish speaking
does not smoke daily (at least 5 cigarettes each day) over the last week
not willing to attend visits at his/her PCC (primary care clinic) or alternative testing site at baseline and 6 months (2 times over a 6 month period), provide urine or exhaled carbon monoxide samples, and complete follow-up phone calls.
not willing to inform the WTQL as to any change in address, phone number, clinic attended, or health plan.

Arm && Interventions

Group	Intervention	Description
Control	Counseling from WTQL	Counseling from WTQL
Incentive	Counseling from WTQL	Counseling from WTQL; Financial incentive to participate
Incentive	Financial incentive to participate	Counseling from WTQL; Financial incentive to participate

Primary Outcome Measures

Name	Time	Method
Abstinence From Smoking	Measured 6 months after enrollment at follow-up assessment	The primary outcome data will be the biochemically confirmed abstinence using urine (measured cotinine) or exhaled (breath) carbon monoxide (CO).

Secondary Outcome Measures

Name	Time	Method
Engagement in Treatment	Measured 6 months after enrollment at follow-up assessment	This analysis will compare number of calls completed
Cost-effectiveness	Measured 6 months after enrollment	This analysis will quantify the costs of treatment for Control and Incentive conditions with regard to attaining 6-month abstinence. Project costs were allocated to three categories: 1) Service costs, including billed staff time for counseling and testing, as well as all incidentals connected with services; 2) Incentives and distribution costs; and 3) Service-related administrative costs, including promotion/marketing and staff time for administering the intervention. Costs of planning the project, grant administration, and research within the project are not included in the analysis.The outcome is the cost per quit in each treatment group. Cost per quit in each group was calculated by: 1) computing the grand total of costs for all participants in a given group; and 2) dividing the grand total for a given group by the number of successful quitters. As such, the cost per quit is a single value with no measure of dispersion.