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8. Volpp KG, Troxel AB, Pauly MV, et al. A randomized, controlled trial of financial incentives for smoking cessation. ;360:-

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14. Vinnikov D, Brimkulov N, Burjubaeva A. A double-blind randomised placebo-controlled trial of cytisine for smoking cessation in medium-dependent workers. ;3:-

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37. The health consequences of smoking — 50 years of progress: a report of the Surgeon General. Atlanta: Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 ().

 

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In summary, this trial shows that among several financial-incentive programs for smoking cessation, rewards for smoking cessation are more effective overall than are deposit-based contracts owing to their much higher rate of acceptance. In addition, the efficacy of deposit-based contracts among those who use them and the cost-effectiveness of such contracts for employers suggest that future innovations in employee benefit design should seek to establish the effectiveness of smoking-cessation programs requiring deposits smaller than the $150 used in this trial.


This study also has several strengths. In addition to comparing financial incentives for smoking cessation in a large number of participants, the trial measured the specific contributions of acceptance and efficacy of the interventions to their overall effectiveness. This trial also compared multiple incentive programs with design features based on behavioral economic theory, including repeated payments to reinforce target behaviors, bonus payments at the end of the intervention to offset smokers’ tendencies to discount the importance of future events, and the provision of ongoing feedback regarding participants’ accrued gains and losses contingent on their self-reported smoking status to maximize the effect of regret aversion. Finally, this trial randomly selected participants for screening cotinine tests to prevent nonsmokers from enrolling. The robustness of our findings in analyses accounting for potential participation of nonsmokers provides strong evidence regarding the effectiveness of incentives.


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We therefore evaluated incentive programs for smoking cessation that are based on rewards or deposit contracts and that are delivered at the individual or group level, comparing the interventions on three measures: acceptance, defined as the proportion of people who accept the incentive program when offered; overall effectiveness, assessed as the proportion of people offered each program who stop smoking; and efficacy, assessed as the proportion of people who stop smoking if they accept a given incentive program.

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Financial incentives have been shown to promote a variety of health behaviors. For example, in a randomized, clinical trial involving 878 General Electric employees, a bundle of incentives worth $750 for smoking cessation nearly tripled quit rates, from 5.0% to 14.7%, and led to a program adapted by General Electric for its U.S. employees. Although incentive programs are increasingly used by governments, employers, and insurers to motivate changes in health behavior, their design is usually based on the traditional economic assumption that the size of the incentive determines its effectiveness. In contrast, behavioral economic theory suggests that incentives of similar size may have very different effects depending on how they are designed.

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24. Mottillo S, Filion KB, Belisle P, et al. Behavioural interventions for smoking cessation: a meta-analysis of randomized controlled trials. ;30:-

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22. Fagerstrom K, Furberg H. A comparison of the Fagerström Test for Nicotine Dependence and smoking prevalence across countries. ;103:-