{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T02:46:42Z","timestamp":1791254802839,"version":"4.1.0"},"reference-count":34,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2025,3,1]]},"abstract":"<jats:sec><jats:title>Importance<\/jats:title><jats:p>The optimal configuration of a smoking cessation intervention in a lung cancer screening (LCS) setting has not yet been established.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the efficacy of 3 tobacco treatment strategies of increasing integration and intensity in the LCS setting.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>In this randomized clinical trial, LCS-eligible current smokers were randomized into 3 treatments: quitline (QL), QL plus (QL+), or integrated care (IC). The study was conducted from July 2017 to June 2022 at a hospital-based tobacco treatment clinic in Houston, Texas.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>The QL intervention group had quitline referral and 12-week nicotine replacement therapy (NRT). The QL+ group had quitline referral plus 12-week NRT or pharmacotherapy prescribed by the LCS clinician. The IC group had 12-week NRT or prescription pharmacotherapy and counseling provided by tobacco treatment specialists within the LCS health care environment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The original primary outcome was biochemically verified 7-day point prevalence abstinence at 6 months; however, this was changed to self-reported abstinence during the conduct of the study due to COVID-19 pandemic restrictions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 630 participants, 320 (50.8%) were male, and the median (IQR) age was 59 (55-64) years. Participants smoked a median (IQR) of 20 (15-25) cigarettes per day. Each cohort (QL, QL+, and IC) was composed of 210 participants. The median (IQR) number of counseling sessions was 4 (2-5) sessions for both QL and QL+ and 8 (7-9) sessions for IC. At 3 months, 53 participants (25.2%) in QL, 57 (27.1%) in QL+, and 78 (37.1%) in IC reported abstinence. IC outperformed both QL (odds ratio [OR], 1.75 [95% CI, 1.15-2.66]; <jats:italic>P<\/jats:italic>\u2009=\u2009.01) and QL+ (OR, 1.58 [95% CI, 1.05-2.40]; <jats:italic>P<\/jats:italic>\u2009=\u2009.03). At 6 months, IC maintained the highest rate of abstinence with 68 individuals (32.4%), followed by QL+ at 58 (27.6%) and QL at 43 (20.5%). IC outperformed QL at this time point (OR, 1.86 [95% CI, 1.19-2.89]; <jats:italic>P<\/jats:italic>\u2009=\u2009.01). In the bayesian analysis, IC demonstrated a higher probability of positive absolute risk differences (ARDs) in abstinence at 3 months vs QL (ARD, 0.12) with 99% probability of positive ARD, and QL+ (ARD, 0.10) with 98% probability of positive ARD. This advantage was maintained at 6 months with ARDs of 0.12 for QL (probability of positive ARD, 99%) and 0.05 for QL+ (probability of positive ARD, 86%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this randomized clinical trial, IC involving medication and intensive counseling provides the best opportunity for smoking cessation relative to QL counseling, with or without LCS clinician\u2013managed medication. 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