Metabolism Informed Smoking Treatment for Smoking Cessation in Medicaid and Medicare Patients

Inclusion Criteria

• 18 years old or older
• Be enrolled in or pending approval for an insurance plan that supports prescription coverage for smoking cessation medication (including Medicare part D, Medicaid, private insurance, Federal or other governmental, or other insurance) or willing and able to purchase smoking cessation medication and pay for healthcare out of pocket to facilitate delivery of medications
• Have a regular provider/PCP or have access to a free or low cost clinic for regular clinical care that can prescribe smoking cessation medication; if patient does not have a PCP, the study team may collaborate with the patient to establish a primary care provider
• Agree to quit or try to quit smoking upon study enrollment
• Be a daily smoker when smoking normally during the month prior to entering the study
• Be medically eligible to use varenicline * Medical eligibility to take varenicline is defined by absence of the following: ** Serious brain condition that impairs cognition (including but not limited to dementia, delirium, brain tumors/metastases, uncontrolled seizures [i.e., seizures within the past 3 months [mo.]) ** Pregnancy/planning to become pregnant/breastfeeding in the next year ** History of allergic reaction to varenicline ** Unstable/uncontrolled mental health condition: *** Altered mental status (e.g., delirium, hallucinations) OR *** Serious psychiatric symptoms in the past 6 months as defined by suicidal ideation or attempt, hospitalization or emergency department (ED) visit involving a psychiatric condition (e.g., depression, anxiety, bipolar, schizophrenia, schizoaffective disorder, post-traumatic stress disorder (PTSD), substance use (e.g., overdose), other related) OR *** Changes in psychiatric medication within the past 3 months ** If alcohol use; history of blackouts or seizures with drinking
• Be medically eligible to use nicotine replacement therapy * Medical eligibility to use nicotine replacement therapy is defined by absence of the following: ** Unstable from cardiovascular perspective ** Current or history of Buerger’s disease (also called thromboangiitis obliterans) ** Pregnant/planning to become pregnant/breastfeeding in the next year
• Have received medication recommendations from a tobacco counselor
• Agree to take smoking cessation medication (i.e., varenicline OR nicotine replacement therapy) home and consider using it
• Have a cell phone or landline that can be reached directly (i.e., without transfer)
• Have a permanent address where they live and can receive mail
• Estimated life expectancy of at least one year or greater

Exclusion Criteria

• Insufficient time to perform and complete the enrollment process
• Barrier to effective communication (including low English proficiency)
• Not cognitively able to participate in the study
• Too ill, on hospice, or physically unable to participate in the follow-up process
• Previously completed the MIST study or is currently enrolled in a quit smoking study that involves a medication-based treatment
• Estimated life expectancy of less than one year