Bigger rewards boost tobacco quit rate

People offered several hundred dollars to quit smoking over the course of a year are three times more likely to kick the habit than those who receive counseling information but no financial reward, researchers report in the Feb. 12 New England Journal of Medicine.

Past studies awarding cash for quitting have yielded mixed results. Some of those studies had few participants and offered small rewards, says Kevin Volpp, an internist and health researcher at the University of Pennsylvania School of Medicine in Philadelphia. The new report, which he coauthored, “is the largest study that’s been done on financial incentives for smoking in a workplace setting,” he says. It also paid well.

Volpp and his colleagues teamed with General Electric to recruit 878 of the company’s employees who smoked. Half were randomly assigned to get $750 for quitting for at least nine months.

All study volunteers received information on local smoking-cessation programs.

Study volunteers assigned to get additional cash for quitting received $100 for completing one of these programs; $250 more if they had stopped smoking in the first three months; and $400 more if they were still nonsmokers six months after that.

Knowing the difficulties of stopping smoking, the researchers gave people in either group who failed to quit during the first three months of the study a second chance to quit and interviewed them again three months later. Among the incentive group, those who succeeded in kicking the habit at that point received the $250 cash reward and the final installment six months later, if still clean.

Researchers verified that people had quit by using a standard saliva test that reveals the presence of cotinine, a metabolite of nicotine. People using a nicotine patch or gum submitted a urine sample to verify that they hadn’t been smoking.

After nine or 12 months, nearly 15 percent of the incentive group had quit, compared with 5 percent of those not receiving the bonuses. Assessments done before and after these time points also showed benefits from the incentives (see chart).

“This was a really well-run study,” says psychologist Deborah Hennrikus of the University of Minnesota in Minneapolis, who wasn’t involved in the research. She and her colleagues had found in earlier research that modest rewards of $10 and $25 could double smokers’ participation rates in cessation programs — but that the money had little effect on quit rates over time.

The long-term data at nine months are particularly important, Hennrikus says. “Most people fall off the wagon in the first week,” she says. “But you don’t expect a lot of relapses after six months.”

While about 70 percent of U.S. smokers say they want to quit, only about 2 to 3 percent do so in any given year, the study authors note. “Incentives provide a tangible reward for people to quit,” says Volpp. “Humans have a lot of trouble doing things solely for the sake of health benefits.”

Incentives can also work in people abusing illegal addictive drugs and to some extent in obese people trying to lose weight, says behavioral researcher Rebecca Donatelle of Oregon State University in Corvallis. She and her colleagues have recorded a cigarette quit rate of 34 percent at six months among low-income pregnant smokers — after offering the women a $50-per-month incentive for stopping.

“I think that incentives are basically the wave of the future,” Donatelle says. “When you think about it, $800 is a minimal investment [for stopping] something that will cost the health care system thousands in a lifetime.”