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Cash incentives encourage smoking cessation.

Paying people to quit smoking significantly increased smoking-cessation rates, compared with a control strategy that had no financial incentives, according to a workplace-based study.

Previous studies of workplace-based financial incentives to help people quit smoking have used small sample sizes and small payments, wrote Dr. Kevin G. Volpp of the University of Pennsylvania in Philadelphia, and colleagues.

The researchers randomized 442 adult smokers to receive information about smoking-cessation programs and 436 to receive information about smoking-cessation programs plus a financial incentive. The participants volunteered for the study after being identified through a survey about smoking habits. Those who used tobacco products other than cigarettes were excluded.

The financial incentive was $100 to complete a smoking-cessation program, plus $250 for confirmed cessation of smoking at 3 or 6 months after entering the study. In addition, participants received $400 for smoking cessation 6 months after the previous date of confirmed smoking cessation (9 months or 12 months). They were also assessed for smoking status (but were not paid) after another 6 months (15 or 18 months after study enrollment). The smoking-cessation program was not based at the workplace; instead, participants were advised to use existing programs in the community.

The study population included adults aged 18 years and older who reported smoking at least five cigarettes daily. Demographic traits were similar between the two groups. The participants were followed for at least 12 months, and the study's primary end point was smoking cessation 9 or 12 months after study enrollment.

Overall, the rate of confirmed smoking cessation (based on a cotinine test) at 9 months or 12 months was about 3 times greater in the financial incentive group, compared with the control group (15% vs. 5%). The smoking-cessation rate within 6 months of starting the study was significantly higher in the financial incentive group, compared with the control group (21% vs. 12%). And the cessation rate remained significantly higher in the financial incentive group, compared with the control group at 15 or 18 months (9% vs. 4%).

Significantly more individuals in the financial incentive group than in the control group enrolled in (15% vs. 5%) and completed (11% vs. 3%) a smoking-cessation education program. Those in the financial incentive group who took part in the smoking-cessation program had higher smoking-cessation rates, compared with controls who took part in the program (46% vs. 21%).

"Targeted payments for smoking cessation have the advantage of being unbundled from health insurance premiums and thus may be more salient to people, thereby having a greater influence on behavior," the researchers said (N. Engl. J. Med. 2009;360:699-709).

The relapse rates between the 9- or 12-month follow-up and the 15- or 18-month follow-up were 36% in the financial incentive group and 27% in the control group. Although those results were higher than those found in other studies, the difference may be negligible compared with other studies, the researchers noted, because so few participants in the current study quit smoking.

The study was limited by its majority of white adults (90%) with high levels of income and education, the researchers noted. More research is needed to assess the effect of financial incentives on employees with lower socioeconomic status and on those of different ethnicities, they added.

The study was supported in part by grants from the Centers for Disease Control and Prevention and the Pennsylvania Department of Health. Dr. Volpp has received lecture fees from Aetna Inc. and grant support from Aetna and Pfizer Inc.
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Author:Splete, Heidi
Publication:Clinical Psychiatry News
Date:Apr 1, 2009
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