Financial incentives may help adults quit smoking in the long-term

Providing financial incentives to low-income smokers led to increased long-term rates of smoking cessation, according to a study in Switzerland.

Researchers Jean-François Etter, PHD and Felicia Schmid, MA, of the University of Geneva in Switzerland, and colleagues published their findings online in the Journal of the American College of Cardiology on Aug. 15.

Previous studies showed financial incentives are effective for smoking cessation, but the researchers mentioned that it was uncertain if the incentives had a sustained effect.

For this study, funded by the Swiss Tobacco Prevention Fund, the researchers enrolled 805 participants in Geneva, Switzerland, between August 2011 and May 2013. The participants were at least 18 years old, had smoked at least five cigarettes a day for at least a year, committed to take part in all follow-up procedures and had taxable income of less than $55,000 if they were single or less than $110,000 if they were married.

The participants were randomized to an intervention group that received financial incentives plus Internet-based support or a control group that received Internet-based support without financial incentives. They received a maximum financial reward of $1,650 if biochemical tests found that they were abstinent at one, two and three weeks and one, three and six months. Neither group received in-person counseling, telephone counseling or medications.

The mean age of participants was 32 years old, and they smoked a mean of 16 cigarettes per day. In the incentive group, 87 percent of participants received at least one reward and 48 percent received all six rewards. The mean award was $1,130 per person.

After six months, 82 percent of participants in the incentive group and 63 percent of participants in the control group had made a serious attempt to quit smoking. The difference was statistically significant.

One year after the study ended, 9.5 percent of participants in the incentive group and 3.7 percent of participants in the control group had not smoked in the previous 12 months. The rates of seven-day abstinence were also higher in the incentive group at three, six and 18 months.

“Our study supports the idea that large financial incentives produce sustained results, but it differs from previous reports in that it showed that this effect was also observed outside workplace or clinical settings, in a context where personal counseling was not provided to participants and was not available for free elsewhere, and that the effect was sustained 12 (rather than six) months after the final distribution of incentives, in relatively low-income smokers,” the researchers wrote.

The researchers mentioned a few potential limitations of the study, including that the participants lived in a small urban area and were mostly students. Thus, the results may not be generalizable to other groups. Smokers in the study were also younger, more educated, more motivated to quit smoking and smoked more cigarettes per day than a representative sample of smokers in Geneva. In addition, the biochemical tests could have affected the smoking cessation rates.

“Substantial financial incentives have a sustained impact on smoking cessation among relatively low-income smokers, both inside and outside of workplace or clinical settings, even when personal counseling is not provided,” the researchers wrote. “The effect is sustained 12 months after the final distribution of incentives. Further studies are needed to assess the net health care costs and savings that accrue from programs that offer large financial incentives for smoking cessation across a wide array of socioeconomic groups and practice settings.”