Randomized, Controlled Trial of Financial Incentives for Smoking Cessation - Randomized, Controlled Trial of Financial Incentives for Smoking Cessation

Feb 11, 2009
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Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Date Published:
01/01/2009
Date Updated:
02/11/2009
Original Posted Date:
02/11/2009
References

Description:

The goal of the trial was to evaluate the efficacy of a smoking cessation program with financial incentives compared with a smoking cessation program without financial incentives.

Hypothesis:

A smoking cessation program with financial incentives would be more effective in increasing rates of long-term smoking cessation.

Study Design

  • Randomized
  • Placebo Controlled

Patients Screened: 1,903
Patients Enrolled: 878
Mean Follow Up: 18 months
Mean Patient Age: 46 years
Female: 34%

Patient Populations:

  • Employed individuals at least 18 years of age who were smoking at least 5 cigarettes per day

Exclusions:

  • Use of tobacco in a noncigarette product
  • Anticipated departure from the company within 18 months

Primary Endpoints:

  • Smoking cessation at 9 or 12 months after enrollment

Secondary Endpoints:

  • Smoking cessation within the first 6 months after enrollment
  • Enrollment in a smoking cessation program
  • Completion of a smoking cessation program

Drug/Procedures Used:

Smokers in a large corporation were randomized to a financial incentive program along with a smoking cessation program (n = 436) versus a smoking cessation program alone (n = 442).

Principal Findings:

Overall, 878 participants were randomized. There were no differences between the study groups. Within the incentive group, the mean age was 46 years, 34% were women, 66% made more than 500% of the poverty level, and the mean number of cigarettes per day was 20.

The primary outcome, smoking cessation at 9 or 12 months, was observed in 14.7% of the incentive group versus 5.0% of the information-only group (p < 0.001). Smoking cessation at 15 or 18 months was observed in 9.4% versus 3.6% (p < 0.001), enrollment in a smoking cessation program was 15.4% versus 5.4% (p < 0.001), completion of a smoking cessation program was 10.8% versus 2.5%, and smoking cessation within 6 months of enrollment was 20.9% versus 11.8% (p < 0.001), respectively, for the incentive group versus the information-only group. Among all subgroups tested, smoking cessation favored the incentive group.

Interpretation:

Among currently employed smokers, a smoking cessation program along with financial incentives was more effective at improving smoking cessation rates at 9 or 12 months and at 15 or 18 months. A financial incentive in the amount of $750 is effective at improving enrollment and completion of smoking cessation programs and increasing long-term rates of smoking cessation. The effect of this approach beyond 18 months is unknown.

While rates of smoking have significantly decreased in the past several decades, tobacco remains a leading cause of mortality in the United States. Previous incentive-based smoking cessation studies were unable to detect a benefit of this approach due to small sample size, limited follow-up, and small financial incentives. This may prove to be a cost-effective strategy for reducing the rates of smoking and its adverse health consequences.

References:

Volpp KG, Troxel AB, Pauly MV, et al. A randomized, controlled trial of financial incentives for smoking cessation. N Engl J Med 2009;360:699-704.

Clinical Topics: Cardiovascular Care Team

Keywords: Motivation, Behavior Therapy, Follow-Up Studies, Health Promotion, Tobacco, Smoking Cessation, Poverty


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