Randomized Trial of Four Financial-Incentive Programs for Smoking Cessation

Smoking cessation is still a heavily researched and talked about topic.  While quitting smoking may seem simple to a non-smoker, the reality is that trying to stop smoking can be a difficult and expensive choice.  This study looked at how financial incentives may increase sustained abstinence from smoking.

2,538 people enrolled in the study and were then assigned to either one of four incentive programs or the usual care for smoking cessation.  Of the the four incentive programs, two were targeted to individuals and two were targeted to groups of six.  These two groups then differentiated by being either a reward-based program or a deposit-based program (refundable deposit plus a reward).  The results of the study showed that while 90% of participants accepted the assignment when the program was reward-based, only 13.7% of participants accepted the assignment when the program was deposit-based.  After six months, rates of sustained abstinence were higher for every program (9.4% to 16.0%) than the basic care group (6.0%).  Additionally, the reward-based programs had higher abstinence rates than the deposit-based programs.

I found the results of this study surprising.  I understand that stopping smoking can be extremely difficult but I still expected the percentage of abstinence to be higher when the reward was $800 for six months of abstinence.  One of the programs had an extremely high denial rate.  It required people to deposit $150 dollars, which they would get back if they successfully completed the six months.  After seeing the results, I now understand why the amount was so low.  Incentive-programs like these do make a significant difference.  However, with the percentages being so low I find it hard to believe that anyone would fund the program without a financial incentive, which only comes from the deposit-based reward system that most smokers would not attempt.

Halpern SD, French B, Small DS, et al. Randomized Trial of Four Financial-Incentive Programs for Smoking Cessation. N Engl J Med. 2015;372(22):2108-117.


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