An analysis of enrollment rates by admitting service for a secondary analysis of enrollment data from a randomized smoking-cessation trial (FIESTA)

Introduction: Enrollment into clinical trials is challenging and has a major effect on the feasibility and the generalizability of a study. We used data from a previously completed hospital-based smoking cessation study to determine if enrollment rates varied by hospital admitting service, specifically comparing Medicine and Psychiatry departments. Methods: We examined enrollment in the Financial Incentives for Smoking Cessation (FIESTA) study, which was conducted at the Veterans Affairs New York Harbor Healthcare System. FIESTA tested the effectiveness of financial incentives on smoking cessation among hospitalized patients. A total of 268 patients were eligible, with 182 enrolled in the original FIESTA study. In our secondary analysis, a LASSO approach was applied to the data set to create a model examining admitting service, age, sex, race and ethnicity, education, and number of cigarettes per day and their association with enrollment. Results: The enrollment rates were higher for patients admitted to the Psychiatry service (80.2%) than to the Medicine and other services (59.9%). Patients with a high school education or less also had a higher enrollment rate (87.2%) than those with higher education (57.7%). Increasing age was associated with lower odds of enrollment (aOR = 0.97, 95% CI: 0.94, 0.99). Hispanic ethnicity appeared to associate with a higher odds of enrollment compared to non-Hispanic White (aOR = 2.52, 95% CI 1.11, 5.75). Higher odds of enrollment were observed among patients admitted to the Psychiatry service (aOR = 2.51, 95% CI: 1.23–5.12), while lower odds were observed among those with higher education (aOR = 0.17, 95% CI: 0.06–0.49). Conclusions: This research suggests that smoking cessation programs can effectively enroll a diverse patient population, including typically underrepresented groups such as those with lower education status and those with mental health diagnoses. Such enrollment efforts would enable studies to be more generalizable to the smoking population. Findings also emphasize the potential of urban hospital settings to support equitable enrollment efforts. The present work is a secondary analysis of the FIESTA RCT (NCT02506829). Future research should explore additional demographic factors, such as comorbidities and confidence in quitting, to better understand motivations for participation.