Financial Incentives for Smoking Cessation

Study Questions:

Do financial incentives together with pharmacologic therapies and/or e-cigarettes promote smoking cessation?

Methods:

This was a pragmatic trial, which included smokers employed from 54 companies. Smokers were assigned to one of four interventions or usual care (access to information on the benefits of smoking cessation and to a motivational text-messaging service). The interventions included usual care plus one of the following: 1) either free cessation aids (nicotine-replacement therapy or pharmacotherapy, with e-cigarettes if standard therapies failed); 2) free e-cigarettes without a requirement that standard therapies be tried; 3) free cessation aids plus $600 in rewards for sustained abstinence; and 4) free cessation aids plus $600 in redeemable funds, deposited in a separate account for each participant, with money removed from the account if cessation milestones were not met. The primary outcomes were smoking abstinence for 6 months after the target quit date. Smoking cessation was confirmed through measurement of cotinine levels in the urine. Primary analyses were conducted with the intention-to-treat approach for all participants who were randomized. A secondary analysis was conducted among engaged participants defined as participants who accessed the trial website one or more times.

Results:

Of the 6,131 smokers who were invited to enroll, 125 opted out and 6,006 underwent randomization. Participants (n = 1,191) in the engaged group were more likely to be female, more highly educated, have greater motivation for quitting, and have used e-cigarettes in the past. Sustained abstinence rates through 6 months were 0.1% in the usual care group, 0.5% in the free cessation aids group, 1.0% in the free e-cigarettes group, and 2.0% in the rewards group, and 2.9% in the redeemable deposit group. Redeemable deposits and rewards were superior to free cessation aids (p < 0.001 and p = 0.006, respectively). Redeemable deposits were superior to free e-cigarettes (p = 0.008). Free e-cigarettes were not superior to usual care or to free cessation aids. Among the 1,191 employees who actively participated in the trial, sustained abstinence rates were four to six times as high as those among participants who did not actively engage in the trial, with similar relative effectiveness.

Conclusions:

The authors concluded that financial incentives added to free cessation aids resulted in a higher rate of sustained smoking abstinence than free cessation aids alone. Among smokers who received usual care (information and motivational text messages), the addition of free cessation aids or e-cigarettes did not provide a benefit.

Perspective:

These data support the use of financial incentives together with cessation aids to promote smoking cessation. However, the data also suggest that increasing motivation for smoking cessation is important to improve quit rates as well.

Clinical Topics: Prevention, Smoking

Keywords: Cotinine, Financial Management, Intention to Treat Analysis, Motivation, Nicotine, Primary Prevention, Reward, Smoking, Smoking Cessation, Text Messaging, Tobacco Products, Tobacco Use Cessation Products


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