Occupational
Enrollment Outcomes in a Tobacco Cessation Trial for World Trade Center Responders Alexandra Mueller* Alexandra Mueller Mueller Mueller Mueller Mueller Mueller Mueller Mueller Mueller Mueller Montefiore Medical Center/FDNY
Introduction: New York City Fire Department (FDNY) responders exposed to the World Trade Center (WTC) disaster face elevated risks of smoking-related diseases. Despite declining smoking rates among FDNY responders, partly due to the Tobacco Free at FDNY Program, which offers free medication and counseling, some continue to smoke. We evaluated whether an Enhanced Care (EC) strategy using opt-out enrollment increases program participation compared with Standard Care (SC) using opt-in enrollment.
Methods: We conducted a randomized trial among retired, currently smoking, WTC-exposed FDNY responders eligible for low-dose chest computed tomography (CT) screening (N=312, 156/arm). EC included opt-out enrollment, counseling tailored to prior CT/spirometry findings, and varenicline with pre-loading. SC used opt-in enrollment with standard counseling and varenicline pre-loading. The primary outcome was enrollment; exact logistic regression compared enrollment odds between groups. We compared baseline characteristics of enrollees vs. non-enrollees and summarized smoking outcomes among enrollees.
Results: 23 participants enrolled in treatment: 17/156 (10.9%) in EC and 6/156 (3.8%) in SC. 19/23 enrolled participants (82.6%) were male, with a median age of 62 (IQR: 58-67) at baseline. EC had 3 times the odds of enrolling compared with SC (OR=3.1; 95% CI=1.1-9.7). Cessation findings are descriptive given small samples. Cessation at 12 weeks was observed in 7/16 (43.8%) of retained participants. Smoking reduction was observed in 90% of EC (9/10) and 100% of SC (3/3).
Conclusion: This is the first trial to test a bundled tobacco cessation strategy, combining opt-out enrollment with CT/spirometry-informed counseling, within an occupational lung cancer screening program. This model increased enrollment, engagement, and short-term smoking reduction. Proactive, tailored cessation delivery may improve reach in hard-to-treat people. These results support further testing in larger studies.