Smoking Cessation Intervention During Low Dose CT (LDCT) Screening for Lung Cancer

Study Groups:

If you are found to be eligible to take part in this study, you will have a CT scan of your
chest to look for signs of lung cancer. You will receive the results 0-4 days after the scan.
If there are any abnormal areas, you will be referred to your regular doctor for follow-up.
No matter what the results are, you will be advised to quit smoking. If you have previously
had a low dose CT scan for lung cancer screening in the last 30 days, you may still be
eligible to participate in this study. You will be asked to provide documentation of the CT
scan results.

You will receive a referral for counseling to help you reduce/quit smoking. You may also
discuss medications you can take to reduce smoking.

As part of your counseling treatment, you may be prescribed an FDA-approved and commercially
available anti-smoking drug. This may be either nicotine replacement therapy (such as a
patch, gum, or lozenge) or an oral drug (such as varenicline or buproprion). The provider
will tell you when and how much of your anti-smoking drug you should take each time, based on
a discussion between you and your provider. Receiving anti-smoking medication will be done
through your counseling treatment and not as part of your participation in this study.

You will have at least 5, but no more than 8, smoking cessation counseling sessions over the
next 12 weeks. Each session will last between 30 - 60 minutes, in which you will set a quit
date, prepare for your quit date, and discuss coping skills for dealing with smoking
"triggers" after your quit date. You will also discuss challenges you may have with quitting.

Study Visits:

You will have 3 additional study visits, at around 6 weeks, 12 weeks, and 6 months after the
screening visit, as well as 1 follow-up phone call. At all study visits:

- You will complete questionnaires about several topics, including depression, suicide,
and your smoking behavior. These questionnaires should take about 30-45 minutes in total
to complete.

- Your CO level will be measured.

- Urine and/or saliva may be collected (at 12 weeks and 6 months only) for a routine test
to check your cotinine and nicotine. Cotinine is a chemical released in your body when
it breaks down nicotine and will show whether and how much you have recently smoked.

Follow-Up:

About 5 months after you start receiving counseling sessions, you will be called by a member
of the study staff and asked about your recent smoking behaviors and habits. This call should
last about 5-10 minutes.

Inclusion Criteria:

1. Age: 50 or older

2. Reports being a daily or non-daily smoker (any self-reported smoking in the past 30
days) and is interested in treatment that might change smoking behavior.

3. Meets guidelines for lung cancer screening, as determined by radiology team

4. Able to follow verbal and written instructions in English and complete all aspects of
the study.

5. Provide informed consent and agree to all assessments and study procedures.

6. Have an address and telephone number where he/she may be reached.

7. Be the only participant in his/her household on active treatment in Protocol 2016-0626
at the time.

8. Following good clinical practice guidelines, be medically suitable for one or more
pharmacotherapies for smoking cessation including NRT, bupropion or varenicline, at
provider discretion.

9. Willing and able to undergo low dose CT scan, as determined by radiology team,or has
had a lung cancer screen within 30 days of enrollment into this protocol.

Exclusion Criteria:

1. Current enrollment or plans to enroll in another smoking cessation program in the next
9 months.

2. Unwilling to refrain from other nicotine substitutes (i.e., OTC or prescription
medication for smoking cessation) or smoking cessation treatments in the next 9
months.

3. Current use of certain medications: (1) Smoking cessation meds (last 7 days), i.e.,
Wellbutrin, Bupropion, Zyban, NRT, Chantix.

4. A positive urine pregnancy test during the screening period. Women who are one year
post-menopausal, or who have had a tubal ligation or a partial or full hysterectomy
will not be subject to a urine pregnancy test.

5. Pregnant, breast-feeding or of childbearing potential and is not protected by a
medically acceptable, effective method of birth control while enrolled in the study.
Medically acceptable contraceptives include: (1) approved hormonal contraceptives
(such as birth control pills, patches, implants or injections), (2) barrier methods
(such as a condom or diaphragm) used with a spermicide, or (3) an intrauterine device
(IUD). Contraceptive measures sold for emergency use after unprotected sex are not
acceptable methods for routine use.

6. Exclusive use of tobacco products other than cigarettes, such as (but not limited to)
cigars, chew, snuff, pipe or e-cigs.