Published in the Journal of the American Medical Association on October 5, 2026, the Healthy Lungs trial found that adding cash incentives of up to $600 nearly doubled sustained tobacco abstinence among underserved patients referred for lung cancer screening.
Testing Interventions for Underserved Patients
Yet half of the people who undergo screening continue to smoke. Reaching those individuals requires targeted support. The Healthy Lungs trial tested interventions on patients referred for lung cancer screening (LCS) who smoked combustible tobacco daily and belonged to historically underserved communities.
Participants included rural residents, individuals living in poverty, people whose highest level of education was a high school degree, and Black or Hispanic patients. Participants were not initially told that the study focused on smoking cessation, which helped researchers enroll a broad cross-section of people with varying personal interest in quitting. The study was conducted by the Leonard Davis Institute of Health Economics (LDI). It included authors such as Rachel Kohn, Kevin Volpp, Dylan Small, Alisa Stephens-Shields, Scott Halpern, and colleagues.
Testing Four Interventions in the Trial
Researchers randomly assigned trial participants into four groups with increasingly robust, additive interventions.
- Group 1 (Resources): Received usual care consisting of referrals to tobacco-cessation assistance programs or quitlines.
- Group 2 (Medicine): Added free pharmacotherapy, including direct-mail nicotine-replacement therapy (NRT) and reimbursement for prescribed smoking-cessation medicines.
- Group 3 (Money): Added cash incentives of up to $600 for verified quitting, confirmed through blood or urine testing.
- Group 4 (Behavior Change): Added a mobile health resource utilizing episodic future thinking, which helps individuals visualize a detailed future where they are smoke-free.
Participants set a quit date and completed online surveys at two weeks, three months, and six months. Those reporting abstinence underwent nicotine byproduct testing.
Cash Incentives Show Cost-Effectiveness
The trial demonstrated that adding financial incentives alongside quitline referrals and free pharmacotherapy doubled the rate of sustained tobacco abstinence in a hard-to-reach population. Related work also highlights that small cash incentives may help close gaps in heart research, and a separate study published by LDI and CHIBE fellows found that $25 nearly doubled Black and Hispanic clinical trial enrollment. According to Scott D. Halpern, cash payments for quitting are highly cost effective — if not cost saving
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“Cash payments for quitting are highly cost effective — if not cost saving.”
Scott D. Halpern, LDI Senior Fellow
Researchers emphasized that the approach directly rewards the desired outcome rather than just covering treatment processes. As Joanna L. Hart noted, It’s paying people to quit, rather than paying for the process of treatment.
Because no sociodemographic characteristics predicted individual response, the findings apply broadly to patients undergoing lung cancer screening regardless of geography, race, income, or initial interest in quitting.
