Predictors and barriers to accepting smoking cessation support within targeted lung health screening programmes: a mixed method approach.

<bold>Background:</bold> The Quit Smoking Lung Health Intervention Trials (QuLIT-1 and -2) demonstrated providing immediate smoking cessation support within lung cancer screening services substantially improves 12-month exhaled CO confirmed rates. However, only around half of those randomised to the smoking cessation intervention arms took up the offer of support. Method: Using logistic regression, we compared the characteristics of participants in the intervention arm of the QuLIT-2 study who did or did not take up the offer of support. We also interviewed 15 smokers who declined support. <bold>Results:</bold> Of 152 smokers randomised to smoking cessation support (Age 61.3 years 58%±4.8 male), 72 accepted the offer, 15 of whom dropped out, and 80 declined the offer. The 57 treated were more likely to be female [53% vs 40% AOR: 3.30, 95%CI 1.47-7.48] and younger [AOR: 0.90, 95%CI 0.80-0.98]. Compared to smokers living in areas with high deprivation, smokers who accepted support were more likely to live in areas of medium or low deprivation, [IMDQ3: 26% vs 14% AOR: 3.79, 95%CI 1.17-13.47], [IMDQ5: 17%vs 9%, AOR: 4.26, 95% CI 1.11-16.33]. Thematic analysis of the interviews identified three main themes. (1) mental health as a barrier, (2) general beliefs about quitting smoking, and (3): negative attitudes towards smoking cessation support. Discussion: There are significant barriers and inequalities of access to cessation support among these smokers despite their high risk. Efforts need to be made by cessation services embedded in lung screening clinics to be aware of these barriers and design equitable services that meet the needs of all smokers attending.