Offering financial incentives may help smokers quit cigarettes, improve health

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 - Tim Casey
Tim Casey, Executive Editor

Most people find it difficult to quit smoking cigarettes. They have trouble stopping even when they understand the health risks involved. Recently, it’s become more popular to offer smokers cash or financial incentives to quit the addictive habit.

So far, the results have been mixed, although a study of low-income smokers in Switzerland showed that offering money could be effective in certain populations. The results were published in the Journal of the American College of Cardiology on Aug. 15.

During the trial, researchers randomized more than 800 adults who had smoked at least five cigarettes per day for at least a year. One group was offered up to $1,650 if they remained abstinent for six months. The other group didn’t receive any financial rewards if they quit. All participants did receive Internet-based support to help them kick their habit.

Providing money worked in this case. The researchers found that 9.48 percent of participants in the incentive group and 3.71 percent of participants in the control group had not smoked in the previous 12 months.

Participants in the intervention group were also significantly more likely to read a cessation booklet, access online cessation help and ask a friend or family member to help them and encourage them to quit.

It’s unclear whether offering cash would have a significant effect on long-term smoking rates. In an accompanying editorial, Joseph A. Ladapo, MD, PhD and Judith J. Prochaska, PhD, MPH mentioned that financial incentives may be more effective for lower-income smokers because they need the money. They estimated that it would cost $28,050 to convince one smoker to quit for the long-term.

“One has to wonder who will be willing to pay for this initiative,” they wrote. “Even in the worksite setting, where the return on investment may be realized, adoption of financial incentives has been limited…. In translating the intervention to policy, how do we make incentives viable? One option, for perceived fairness, may be offering everyone some type of incentive program matched to his or her health risks. Many pressing, unanswered questions exist concerning the effectiveness and cost-effectiveness of financial incentives for behavior change.”

Some previous research showed that smoking cessation offers good value for payers and may save money from a societal perspective, according to Ladapo and Prochaska. However, they mentioned most studies have not examined the cost-effectiveness of cessation programs and have not compared forms of financial incentives such as cash or vouchers.

“Future work should aim to bridge critical knowledge gaps concerning incentive design and delivery, and ultimately, inform the comparative effectiveness of financial incentives relative to other clinical and behavioral approaches to treating nicotine addiction,” they wrote.