{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T17:42:59Z","timestamp":1792690979760,"version":"4.5.0"},"reference-count":50,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K24DA051807"],"award-info":[{"award-number":["K24DA051807"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000125","name":"National Institute for Occupational Safety and Health","doi-asserted-by":"publisher","award":["5R21OH012256"],"award-info":[{"award-number":["5R21OH012256"]}],"id":[{"id":"10.13039\/100000125","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000125","name":"National Institute for Occupational Safety and Health","doi-asserted-by":"publisher","award":["75D301-22-R-72142"],"award-info":[{"award-number":["75D301-22-R-72142"]}],"id":[{"id":"10.13039\/100000125","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000125","name":"National Institute for Occupational Safety and Health","doi-asserted-by":"publisher","award":["75D301-22-R-72244"],"award-info":[{"award-number":["75D301-22-R-72244"]}],"id":[{"id":"10.13039\/100000125","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Substance Use &amp; Addiction Journal"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>World Trade Center (WTC)-exposed Fire Department of the City of New York (FDNY) rescue\/recovery workers have an elevated risk of smoking-related morbidity. Despite access to free tobacco cessation treatment, some individuals in this population continue to smoke. In other settings, opt-out treatment approaches increase treatment initiation, but effectiveness in occupational health programs is unclear. Accordingly, we (1) assessed whether an opt-out strategy increases engagement with a Tobacco Cessation Program and (2) identified factors associated with engagement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This was a randomized trial among FDNY firefighters and Emergency Medical Service (EMS) who self-reported smoking and were eligible for the WTC Health Program Lung Cancer Screening Program. 1:1 randomization occurred prior to contact for opt-out recruitment with Enhanced Care treatment (Opt-Out\/Enhanced) or opt-in recruitment with Standard Care treatment (Opt-In\/Standard). Opt-Out\/Enhanced included proactive outreach and tailored biofeedback during counseling; Opt-In\/Standard included participant-initiated engagement and standard counseling. Both groups were offered identical no-cost pharmacotherapy (varenicline). Engagement was defined as: consented enrollment (expressed interest and provided informed consent) and treatment initiation (attendance at \u22651 counseling session). Engagement differences were evaluated using logistic regression; sociodemographic and health-related factors were characterized descriptively without formal testing due to small numbers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Overall, 312 individuals were randomized (Opt-Out\/Enhanced, n\u2009=\u2009156 and Opt-In\/Standard, n\u2009=\u2009156). Engagement was low (7.4%). Consented enrollment (n\u2009=\u200923; OR\u2009=\u20093.05; 95% CI\u2009=\u20091.11-9.72) and treatment initiation (n\u2009=\u200918; OR\u2009=\u20092.08; 95% CI\u2009=\u20090.72-6.73) were higher in Opt-Out\/Enhanced versus Opt-In\/Standard. Treatment initiators had a median age of 60.5 (vs 65.0\u2009years among non-initiators); 38.9% were EMS (vs 18.0%), 22.2% were female (vs 6.9%), 77.8% had a prior cessation attempt (vs 23.5%), and 55.6% had abnormal lung function (vs 32.9%). Participants were too few to analyze cessation outcomes in depth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Despite low engagement overall, opt-out treatment had higher engagement with tobacco cessation treatment. This supports other work that has found opt-out treatment to be encouraged for hard-to-reach populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/29767342261489476","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T10:59:47Z","timestamp":1792493987000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Opt-Out Versus Opt-In Recruitment on Engagement of FDNY WTC-Exposed Responders in a Tobacco Cessation Intervention"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-3035-1484","authenticated-orcid":false,"given":"Tyrone","family":"Moline","sequence":"first","affiliation":[{"name":"Fire Department of the City of New York World Trade Center Health Program, Brooklyn, NY, USA"},{"name":"Montefiore Medical Center, Bronx, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4028-6720","authenticated-orcid":false,"given":"Alexandra K.","family":"Mueller","sequence":"additional","affiliation":[{"name":"Fire Department of the City of New York World Trade Center Health Program, Brooklyn, NY, USA"},{"name":"Montefiore Medical Center, Bronx, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Prezant","sequence":"additional","affiliation":[{"name":"Fire Department of the City of New York World Trade Center Health Program, Brooklyn, NY, USA"},{"name":"Montefiore Medical Center, Bronx, NY, USA"},{"name":"Albert Einstein College of Medicine, Bronx, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew P.","family":"Bars","sequence":"additional","affiliation":[{"name":"Fire Department of the City of New York World Trade Center Health Program, Brooklyn, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Zeig-Owens","sequence":"additional","affiliation":[{"name":"Fire Department of the City of New York World Trade Center Health Program, Brooklyn, NY, USA"},{"name":"Montefiore Medical Center, Bronx, NY, USA"},{"name":"Albert Einstein College of Medicine, Bronx, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayris P.","family":"Webber","sequence":"additional","affiliation":[{"name":"Fire Department of the City of New York World Trade Center Health Program, Brooklyn, NY, USA"},{"name":"Montefiore Medical Center, Bronx, NY, USA"},{"name":"Albert Einstein College of Medicine, Bronx, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Fire Department of the City of New York World Trade Center Health Program, Brooklyn, NY, USA"},{"name":"Montefiore Medical Center, Bronx, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3753-6044","authenticated-orcid":false,"given":"Madeline F.","family":"Cannon","sequence":"additional","affiliation":[{"name":"Fire Department of the City of New York World Trade Center Health Program, Brooklyn, NY, USA"},{"name":"Montefiore Medical Center, Bronx, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon","family":"Vaeth","sequence":"additional","affiliation":[{"name":"Fire Department of the City of New York World Trade Center Health Program, Brooklyn, NY, USA"},{"name":"Montefiore Medical Center, Bronx, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia H.","family":"Arnsten","sequence":"additional","affiliation":[{"name":"Montefiore Medical Center, Bronx, NY, USA"},{"name":"Albert Einstein College of Medicine, Bronx, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5501-4942","authenticated-orcid":false,"given":"Shadi","family":"Nahvi","sequence":"additional","affiliation":[{"name":"Montefiore Medical Center, Bronx, NY, USA"},{"name":"Albert Einstein College of Medicine, Bronx, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2682-7543","authenticated-orcid":false,"given":"David G.","family":"Goldfarb","sequence":"additional","affiliation":[{"name":"Fire Department of the City of New York World Trade Center Health Program, Brooklyn, NY, USA"},{"name":"Montefiore Medical Center, Bronx, NY, USA"},{"name":"Albert Einstein College of Medicine, Bronx, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,20]]},"reference":[{"key":"e_1_3_5_2_2","unstructured":"Centers for Disease Control and Prevention. 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