Ellen Wolfson has tried to quit smoking before. A woman in her seventies from Philadelphia, Ellen recognizes it’s a necessary action to improve her health—especially as someone living with heart disease. She first started smoking over 50 years ago, and at one point in her thirties, Ellen was smoking up to two packs a day. Shortly before the start of the COVID-19 pandemic, Ellen had quit smoking cold turkey. Stress and boredom caused by pandemic-associated upheaval though meant Ellen began smoking again.
An estimated 30 million adults in the United States smoke cigarettes, and more than 16 million of them are living with a health condition related to smoking. Smoking can lead to heart disease and stroke and is also the biggest risk factor for lung cancer.
Many people who smoke want to quit, but quitting can be challenging, in part because the nicotine in cigarettes is so addictive. “It’s really hard to quit smoking,” emphasizes Ellen. Yet today, Ellen is once again six months smoke-free. She credits the Healthy Lungs program with providing her support to get there.
This PCORI-funded study is comparing strategies to help people undergoing lung cancer screening to quit smoking. Scott Halpern, MD, PhD, the study's principal investigator, notes that previous trials have studied a variety of approaches to motivate people to quit. Many of these trials did not enroll diverse patient populations, however, and “did not adequately reflect common demographic and socioeconomic characteristics” among people finding it difficult to quit, says Scott; previous studies showed a “tremendous lack of diversity.”
With a focus on lung cancer prevention, the Healthy Lungs team is recruiting 3,200 current smokers referred for lung cancer screening at four large health systems. All patients are from historically underrepresented groups and are Black or Latino/a, have low incomes, have low education levels, or live in a rural area. Over 1,500 people have already been enrolled into the trial with study completion expected in 2025.
This is a big trial, and there are frankly not a lot of opportunities for large-scale, pragmatic effectiveness trials. We knew PCORI would be supportive of designing [this trial] from the get-go with a hefty engagement component.Scott Halpern, MD, PhD Study Principal Investigator
Ellen's primary care doctor first told her about the Healthy Lungs program. The program acknowledges that quitting is difficult and will be an ongoing process, and provides tools, incentives, or other supports for a journey to healthier lungs and a healthier life. Because Ellen was still smoking while living with major health issues, she was motivated to learn more about the program.
Consistently engaging with and learning from members of the communities the program is designed to help has enhanced its effectiveness, shares Scott. Virtual outreach has been important as well, Scott explains, “not just because of the pandemic but because it really meets people where they are.”
By using email and text messaging, the team has been able to reach a more diverse and representative group. Nsenga Farrell, EdD, the program’s Senior Manager of Communications and Engagement, is especially proud of “the ways our team has been able to adapt and tailor our approach to engender a strong sense of belonging for patients and community advisors.”
Due to the stigma around smoking, it can be difficult to promote lung health. Pressure placed on people to quit smoking, rather than an emphasis on the support needed to work toward healthier lungs, can backfire and become disempowering. Ellen shares that as someone who has struggled with smoking for years, she appreciates “not being scrutinized or penalized” during her participation in the Healthy Lungs program. “It’s nonjudgmental support,” she notes.
Ellen also values the 12-month length of the program since it gives her time to break the habit of smoking and form healthier habits in its place. Access to aids such as nicotine patches, lozenges, and gum has also eased the transition for her. “Some people who are uninsured don’t quit because of how expensive all that is,” says Ellen.
The Healthy Lungs program alleviates that concern, Ellen shares, in addition to providing structure and accountability through regular surveys and urine screening tests. “I was a teacher,” she says, “so I understand something about rewards and monitoring" when working toward goals and new habits. Ellen has even recommended the program to others, emphasizing the success of those who have already quit through the program.
“This is a big trial, and there are frankly not a lot of opportunities for large-scale, pragmatic effectiveness trials,” says Scott, explaining the team’s motivation to apply for PCORI funding. “We knew PCORI would be supportive of designing [this trial] from the get-go with a hefty engagement component,” he adds.
The success in quitting smoking that patients like Ellen have experienced demonstrates the power of this patient-centered program. “I’m still tempted to smoke sometimes, but support from the program is really an incentive,” she shares.
Another big motivator, adds Ellen, is how good she feels. Now at six months smoke-free, “I haven’t had any shortness of breath, and I have no chest pain.”
Posted: November 15, 2022