Tobacco Cessation at FDNY

At the Fire Department of the City of New York (FDNY) World Trade Center Health Program, 36% of participants in the low dose computed tomography (LDCT) lung cancer screening program are current smokers, despite referral to the free FDNY Tobacco Cessation Program (Standard Care). Investigators propose testing an Enhanced Care program which includes opt-out enrollment; tobacco cessation counseling will be individually tailored to spirometry/LDCT results and treatment with varenicline starting 4 weeks prior to their target quit date. This randomized trial will compare enrollment and cessation outcomes in Standard Care vs. Enhanced Care groups of challenging-to-treat, high-risk smokers.

Inclusion Criteria * Enrolled in FDNY World Trade Center Health Program (WTCHP) * Retired * Age ≥ 50 years old * Self-reported current smoker on most recent questionnaire OR self-reported current smoker in the past 5 years * 20 pack-year smoker OR 20-year smoking duration Exclusion Criteria * Reduced renal function * estimated glomerular filtration rate (eGFR) \15