Financial Incentives for Long-Term Smoking Cessation

Study Questions:

Do financial incentives influence long-term smoking cessation?

Methods:

This study was a randomized controlled trial comparing two groups of low-income smokers enrolled between 2011 and 2013 from the general population in Geneva, Switzerland. Participants were randomized to either the intervention group which received financial incentives along with educational booklets and access to a smoking cessation website, or the control group which received just the booklets and access to the website. Financial rewards were incremental with a maximum of US $1,650. Rewards were provided after biochemically verified abstinence at 1, 2, and 3 weeks, and 1, 3, and 6 months. No in-person counseling, telephone counseling, or medications were provided. The primary outcome was continuous abstinence between 6 months (end of incentives) and 18 months (12 months after the incentives ended), verified by expired carbon monoxide and salivary cotinine. Biochemically verified 7-day abstinence at 3, 6, and 18 months was also examined.

Results:

A total of 401 participants were randomized to the intervention group (which received financial incentives) and 404 were randomized to the control group. Mean age for the participants was 32 years, and mean number of cigarettes smoked was 16 per day. Mean Fagerstrom score for tobacco dependence was consistent with moderate dependence. Rates of continuous abstinence between months 6 and 18 were 9.5% in the incentive group and 3.7% in the control group (p = 0.001). Rates of 7-day abstinence were higher in the incentive group than in the control group at 3 (54.9% vs. 11.9%, p < 0.001), 6 (44.6% vs. 11.1%, p < 0.001), and 18 (18.2% vs. 11.4%, p = 0.006) months.

Conclusions:

The investigators concluded that among low-income smokers who did not receive face-to-face or telephone smoking cessation counseling, large financial incentives increased long-term rates of smoking cessation.

Perspective:

This study suggests that financial incentives can assist in getting smokers to maintain long-term abstinence even after the incentive ends.

Clinical Topics: Prevention, Smoking

Keywords: Carbon Monoxide, Cotinine, Financial Support, Internet, Poverty, Primary Prevention, Reward, Smoking, Smoking Cessation, Tobacco Use Disorder


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