Integrating Financial Coaching and Referrals into a Smoking Cessation Program for Low-income Smokers: a Randomized Waitlist Control Trial

Background: Financial distress is a barrier to cessation among low-income smokers. Objective: To evaluate an intervention that integrated financial coaching and benefits referrals into a smoking cessation program for low-income smokers. Design: Randomized waitlist control trial conducted from 2017 to 2019. Participants: Adult New York City residents were eligible if they reported past 30-day cigarette smoking, had income below 200% of the federal poverty level, spoke English or Spanish, and managed their own funds. Pregnant or breastfeeding people were excluded. Participants were recruited from two medical centers and from the community. Intervention: The intervention (n = 208) offered smoking cessation coaching, nicotine replacement therapy, money management coaching, and referral to financial benefits and empowerment services. The waitlist control (n=202) was usual care during a 6-month waiting period. Main Measures: Treatment engagement, self-reported 7-day abstinence, and financial stress at 6 months. Key Results: At 6 months, intervention participants reported higher abstinence (17% vs. 9%, P=0.03), lower stress about finances (β, −0.8 [SE, 0.4], P=0.02), and reduced frequency of being unable to afford activities (β, −0.8 [SE, 0.4], P=0.04). Outcomes were stronger among participants recruited from the medical centers (versus from the community). Among medical center participants, the intervention was associated with higher abstinence (20% vs. 8%, P=0.01), higher satisfaction with present financial situation (β, 1.0 [SE, 0.4], P=0.01), reduced frequency of being unable to afford activities (β, −1.0 [SE, 0.5], P=0.04), reduced frequency in getting by paycheck-to-paycheck (β, −1.0 [SE, 0.4], P=0.03), and lower stress about finances in general (β, −1.0 [SE, 0.4], P = 0.02). There were no group differences in outcomes among people recruited from the community (P>0.05). Conclusions: Among low-income smokers recruited from medical centers, the intervention produced higher abstinence rates and reductions in some markers of financial distress than usual care. The intervention was not efficacious with people recruited from the community. Trial Registration: ClinicalTrials.gov