Financial Incentives for Smoking Cessation | Journal Scan

Study Questions:

Are financial incentives associated with increases in smoking cessation?


This randomized controlled trial enrolled CVS Caremark employees, their relatives, and friends who smoked five or more cigarettes per day into one of four incentive programs or usual care. The incentive programs included two programs that focused on individuals and two programs that focused on a group of two participants. One individual focused program and one group-oriented program used awards of approximately $800 for successful smoking cessation. The other two programs (one individual focused and one group focused) used a refundable deposit ($150) and $650 for a reward for successful smoking cessation. Smoking cessation was documented by cotinine levels at 14 days, 30 days, and 6 months. Financial incentive disbursement was at 6 months.


A total of 2,538 participants were enrolled. Acceptance into the deposit-based programs was significantly lower than the reward-based programs (13.7% vs. 90.0%, p < 0.001). Rates of sustained smoking cessation (with up to 6-month follow-up) were higher in the incentive programs (range, 9.4-16.0%) compared to usual care (6.0%). Smoking cessation rates remained high (compared to usual care) for the reward-based programs through 12-month follow-up. Group-oriented and individual-oriented programs were associated with similar 6-month abstinence rates (13.7% and 12.1%, respectively; p = 0.29). Reward-based programs were associated with higher abstinence rates than deposit-based programs (15.7% vs. 10.2%, p < 0.001). However, after adjusting for differences in acceptance of the programs, the rates of successful smoking cessation at 6 months were higher in the deposit-based programs compared to the reward-based programs.


The investigators concluded that incentives for smoking cessation are associated with greater sustained quit rates than usual care. Deposit-based programs are not well accepted compared to reward-based programs; however, they are associated with greater sustained quit rates than reward-based programs. Group-based and individual-based programs are equally effective.


This eloquently designed study suggests that reward-based programs are effective for smoking cessation. Although not well accepted, such a program that includes a deposit resulted in higher smoking cessation. Understanding the acceptability and effectiveness of such programs in other groups is warranted.

Clinical Topics: Prevention, Smoking

Keywords: Adaptation, Psychological, Awards and Prizes, Cotinine, Follow-Up Studies, Motivation, Primary Prevention, Reward, Research Design, Smoking, Smoking Cessation, Tobacco

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